1093989782 NPI number — ANDREA E DEEDS PA

Table of content: ANDREA E DEEDS PA (NPI 1093989782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093989782 NPI number — ANDREA E DEEDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEEDS
Provider First Name:
ANDREA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTRO
Provider Other First Name:
ANDREA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093989782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19604-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-371-7700
Provider Business Mailing Address Fax Number:
610-371-9189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19604-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-371-7700
Provider Business Practice Location Address Fax Number:
610-371-9189
Provider Enumeration Date:
04/15/2008

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: 363A00000X , with the licence number:  MA052609 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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