1689646242 NPI number — REBECCA A DONCHESS MA

Table of content: REBECCA A DONCHESS MA (NPI 1689646242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689646242 NPI number — REBECCA A DONCHESS MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONCHESS
Provider First Name:
REBECCA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1689646242
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:
1032 BOARDMAN-CANFIELD RD
Provider Second Line Business Mailing Address:
# 102
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-726-3339
Provider Business Mailing Address Fax Number:
330-726-0482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 NILES CORTLAND RD NE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44484-1077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-394-3300
Provider Business Practice Location Address Fax Number:
330-609-6190
Provider Enumeration Date:
02/07/2006

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: 231H00000X , with the licence number:  A 01184 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000226441 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04600 . This is a "NATION EAR CARE PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0416651 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000503369 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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