1073793451 NPI number — MRS. PAULA ANN SCARBOROUGH MSPT

Table of content: MRS. PAULA ANN SCARBOROUGH MSPT (NPI 1073793451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073793451 NPI number — MRS. PAULA ANN SCARBOROUGH MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCARBOROUGH
Provider First Name:
PAULA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

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:
1073793451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
276 E HERON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18966-2069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-891-1898
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 GREEN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19007-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-970-3660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2007

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: 225100000X , with the licence number:  PT013309L , 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)





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