1164484853 NPI number — GALINA PRIVOROTSKY M.D.

Table of content: GALINA PRIVOROTSKY M.D. (NPI 1164484853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164484853 NPI number — GALINA PRIVOROTSKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRIVOROTSKY
Provider First Name:
GALINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1164484853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10125 VERREE RD
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19116-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-552-9060
Provider Business Mailing Address Fax Number:
215-552-9065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10125 VERREE RD
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19116-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-552-9060
Provider Business Practice Location Address Fax Number:
215-552-9065
Provider Enumeration Date:
04/06/2006

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: 208000000X , with the licence number:  MD043352E , 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: 6633362001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2949093 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30002272 . This is a "MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E36337 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0416948001 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30002273 . This is a "MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3Y2330 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139131 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32926 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0013962900007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0416948000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2119884001 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4128231 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0282317016 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3037399 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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