1033216163 NPI number — DR. ALAN D. DENNISON MD

Table of content: DR. ALAN D. DENNISON MD (NPI 1033216163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033216163 NPI number — DR. ALAN D. DENNISON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNISON
Provider First Name:
ALAN
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033216163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 MARTER AVE
Provider Second Line Business Mailing Address:
BLDG 500, SUITE 503
Provider Business Mailing Address City Name:
MOORESTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08057-3124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-608-8840
Provider Business Mailing Address Fax Number:
856-722-1898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 MARTER AVE
Provider Second Line Business Practice Location Address:
BLDG 500, SUITE 503
Provider Business Practice Location Address City Name:
MOORESTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08057-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-608-8840
Provider Business Practice Location Address Fax Number:
856-722-1898
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MA65290 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD066265L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010002189 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0523170000 . This is a "AMERIHEALTH, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080128745 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K4985 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P700755 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 263782 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 263786 . This is a "PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1082857 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 799493 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19328 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1839799 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6610430 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7581807 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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