1255516811 NPI number — CATHERINE VIRGINIA O'HAYER PHD

Table of content: CATHERINE VIRGINIA O'HAYER PHD (NPI 1255516811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255516811 NPI number — CATHERINE VIRGINIA O'HAYER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'HAYER
Provider First Name:
CATHERINE
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FENWICK
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
VIRGINIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255516811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 MARKET ST
Provider Second Line Business Mailing Address:
FL 30
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-503-3685
Provider Business Mailing Address Fax Number:
215-955-2420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1427 VINE ST
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-831-4611
Provider Business Practice Location Address Fax Number:
215-831-2603
Provider Enumeration Date:
01/02/2008

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: 103T00000X , with the licence number:  PS017228 , 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)





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