1053319855 NPI number — KRISTEN AGNES WASSEL P.A.-C.

Table of content: KRISTEN AGNES WASSEL P.A.-C. (NPI 1053319855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053319855 NPI number — KRISTEN AGNES WASSEL P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASSEL
Provider First Name:
KRISTEN
Provider Middle Name:
AGNES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRONIN
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
AGNES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053319855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2775 SCHOENERSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-7307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-861-8080
Provider Business Mailing Address Fax Number:
610-807-0366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2775 SCHOENERSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-7307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-861-8080
Provider Business Practice Location Address Fax Number:
610-807-0366
Provider Enumeration Date:
07/14/2005

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: 363A00000X , with the licence number:  MA050778 , 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: 328920 . This is a "HEALTHAMERICA/HEALTHASSUR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50047062 . This is a "KEYSTONE HEALTH CENTRAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3176072 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1958792 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50047062 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 970022170 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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