1538216544 NPI number — MR. GREGG LEONARD MORRIS PA-C

Table of content: MR. GREGG LEONARD MORRIS PA-C (NPI 1538216544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538216544 NPI number — MR. GREGG LEONARD MORRIS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
GREGG
Provider Middle Name:
LEONARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1538216544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 W KYLA MARIE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-266-6509
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 MCMASTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEMBLESVILLLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-255-4466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007

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:  MA051332 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: C5-0000544 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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