1144213638 NPI number — MARK R LABUSKI MD

Table of content: MARK R LABUSKI MD (NPI 1144213638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144213638 NPI number — MARK R LABUSKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABUSKI
Provider First Name:
MARK
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1144213638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4520 UNION DEPOSIT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-652-6105
Provider Business Mailing Address Fax Number:
717-652-2165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4518 UNION DEPOSIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-652-5840
Provider Business Practice Location Address Fax Number:
717-652-8152
Provider Enumeration Date:
08/30/2005

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: 2085R0202X , with the licence number:  MD066666L , 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: 0017911330017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300137782 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017911330016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017911330003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017911330009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017911330011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".