1598766990 NPI number — GEORGE M TOOHEY OD

Table of content: GEORGE M TOOHEY OD (NPI 1598766990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598766990 NPI number — GEORGE M TOOHEY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOHEY
Provider First Name:
GEORGE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1598766990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 FALLOWFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLEROI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15022-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-489-9600
Provider Business Mailing Address Fax Number:
724-539-1654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 FALLOWFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLEROI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15022-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-489-9600
Provider Business Practice Location Address Fax Number:
724-539-1654
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: 152W00000X , with the licence number:  OEG000643 , 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: T0735710 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: T093659 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00433391 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007357100002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007357100001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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