1275534638 NPI number — ARELYNE PACHO MD

Table of content: ARELYNE PACHO MD (NPI 1275534638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275534638 NPI number — ARELYNE PACHO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACHO
Provider First Name:
ARELYNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1275534638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602
Provider Second Line Business Mailing Address:
MARC J MEDWAY MD PC
Provider Business Mailing Address City Name:
GWYNEDD VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19437-0602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-542-7260
Provider Business Mailing Address Fax Number:
215-542-1012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 CENTRAL AVE
Provider Second Line Business Practice Location Address:
MARC J MEDWAY MD PC
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-728-3736
Provider Business Practice Location Address Fax Number:
215-728-3354
Provider Enumeration Date:
08/09/2005

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: 208100000X , with the licence number:  MD0391132 , 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)

  • Identifier: 3364100 . This is a "AETNA US HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0693714000 . This is a "KEYSTONE AMERI HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA4959 . This is a "QUALMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1032748 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01481669 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15768/MD039113L . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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