1023437639 NPI number — LYDIA J DAVIS OD PC

Table of content: DR. THOMAS JOHN COCKAYNE JR. DPM (NPI 1063820231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023437639 NPI number — LYDIA J DAVIS OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYDIA J DAVIS OD 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:
1023437639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 PAOLI PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-4550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-436-6000
Provider Business Mailing Address Fax Number:
610-436-7506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 PAOLI PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-4550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-436-6000
Provider Business Practice Location Address Fax Number:
610-436-7506
Provider Enumeration Date:
04/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LYDIA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-436-6000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000999 , 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: 102799264 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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