1366431207 NPI number — GERALD FRANCIS DRISCOLL JR. CRNP

Table of content: GERALD FRANCIS DRISCOLL JR. CRNP (NPI 1366431207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366431207 NPI number — GERALD FRANCIS DRISCOLL JR. CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRISCOLL
Provider First Name:
GERALD
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
CRNP
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:
1366431207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8118 OLD YORK RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
ELKINS PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-635-3151
Provider Business Mailing Address Fax Number:
215-635-3165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8118 OLD YORK RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ELKINS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-635-3151
Provider Business Practice Location Address Fax Number:
215-635-3165
Provider Enumeration Date:
10/13/2005

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: 363LG0600X , with the licence number:  UP005265H , 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: 0018226880002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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