1285717074 NPI number — CARMEN SPINNEY M.D.

Table of content: CARMEN SPINNEY M.D. (NPI 1285717074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285717074 NPI number — CARMEN SPINNEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPINNEY
Provider First Name:
CARMEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1285717074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17721-0430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-753-5000
Provider Business Mailing Address Fax Number:
570-753-3475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 WOODWARD AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-753-5000
Provider Business Practice Location Address Fax Number:
570-753-3475
Provider Enumeration Date:
10/23/2006

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: 207R00000X , with the licence number:  MD033890L , 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: P00153396 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010467570002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002669 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 18176 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5445312 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 131918 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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