1932195658 NPI number — DR. SAMUEL H SARRAF III DC

Table of content: DR. SAMUEL H SARRAF III DC (NPI 1932195658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932195658 NPI number — DR. SAMUEL H SARRAF III DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARRAF
Provider First Name:
SAMUEL
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DC
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:
1932195658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 LIGONIER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATROBE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15650-3178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-537-5266
Provider Business Mailing Address Fax Number:
724-537-6703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 LIGONIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATROBE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15650-3178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-537-5266
Provider Business Practice Location Address Fax Number:
724-537-6703
Provider Enumeration Date:
09/27/2005

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: 111N00000X , with the licence number:  DC002535L , 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: 1583046 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".