1134169543 NPI number — CHARLES D. MARLEY JR. DO

Table of content: AIMEE TELSEY MD (NPI 1154302032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134169543 NPI number — CHARLES D. MARLEY JR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARLEY
Provider First Name:
CHARLES
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
DO
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:
1134169543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 GETTYS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GETTYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17325-2534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-338-3242
Provider Business Mailing Address Fax Number:
717-338-3237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 GETTYS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GETTYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17325-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-338-3242
Provider Business Practice Location Address Fax Number:
717-338-3237
Provider Enumeration Date:
06/07/2006

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: 207P00000X , with the licence number:  OS007304E , 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: 1529201 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34560 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 924642 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001286940 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200910 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50072668 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7678716 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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