1770530933 NPI number — PULMONARY MEDICINE PC

Table of content: (NPI 1770530933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770530933 NPI number — PULMONARY MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY MEDICINE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770530933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5325 NORTHGATE DR
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-9411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-625-8898
Provider Business Mailing Address Fax Number:
610-625-8899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5325 NORTHGATE DR
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-625-8898
Provider Business Practice Location Address Fax Number:
610-625-8899
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURLEW
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
PRENTICE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-625-8898

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  MD037049E , 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: 020055700 . This is a "BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02343500 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0618634 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 91964 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 290009012 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: BU608961 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012094500002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P867065 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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