1629178314 NPI number — ANNA HEADLY MD

Table of content: ANNA HEADLY MD (NPI 1629178314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629178314 NPI number — ANNA HEADLY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEADLY
Provider First Name:
ANNA
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:
1629178314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 COOPER PLZ
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-342-2439
Provider Business Mailing Address Fax Number:
856-966-0735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 COOPER PLZ
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-342-2439
Provider Business Practice Location Address Fax Number:
856-966-0735
Provider Enumeration Date:
09/23/2006

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:  MA74930 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8959200 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2795627 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36607 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1472136 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1167971 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K3532 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1472136 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2255382 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000094090 . This is a "OPERATING ENGINEER LOCAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010004725 00 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3065361 . This is a "AETNA US-HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9855308 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110243929 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2155659000 . This is a "AMERIHEALTH, HMO, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".




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