1154350254 NPI number — ELPIDIO D DAMAZO I MD

Table of content: ELPIDIO D DAMAZO I MD (NPI 1154350254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154350254 NPI number — ELPIDIO D DAMAZO I MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAMAZO
Provider First Name:
ELPIDIO
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
I
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:
1154350254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 15TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER FALLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15010-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-846-9150
Provider Business Mailing Address Fax Number:
724-846-4049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER FALLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15010-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-846-9150
Provider Business Practice Location Address Fax Number:
724-846-4049
Provider Enumeration Date:
07/01/2006

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: 207Q00000X , with the licence number:  MD030076L , 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: 001559021004 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010065863 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0467219 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1522633 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251007 . This is a "UPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 214370 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006458470001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000079625 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18314 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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