1013236017 NPI number — DR. DAVID P JEDLICKA AU.D.

Table of content: DR. DAVID P JEDLICKA AU.D. (NPI 1013236017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013236017 NPI number — DR. DAVID P JEDLICKA AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEDLICKA
Provider First Name:
DAVID
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
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:
1013236017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 PROSPECT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16033-3919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-822-6356
Provider Business Mailing Address Fax Number:
412-954-4630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7180 HIGHLAND DR
Provider Second Line Business Practice Location Address:
BUILDING 2, AUDIOLOGY, 132 A-H
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15206-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-954-4647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2010

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:  AT006158 , 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)