1023010014 NPI number — MR. THOMAS G. CHEGWIDDEN CRNA

Table of content: THOMAS L JOHNSON M.D. (NPI 1578506903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023010014 NPI number — MR. THOMAS G. CHEGWIDDEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEGWIDDEN
Provider First Name:
THOMAS
Provider Middle Name:
G.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1023010014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 COMMERCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10801-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-637-3510
Provider Business Mailing Address Fax Number:
914-633-3287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 E BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-6835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-501-4000
Provider Business Practice Location Address Fax Number:
570-501-6203
Provider Enumeration Date:
08/10/2005

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: 367500000X , with the licence number:  RN199182L , 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: PENDING , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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