1174503437 NPI number — DR. ROBIN L PLANK D.O.

Table of content: DR. ROBIN L PLANK D.O. (NPI 1174503437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174503437 NPI number — DR. ROBIN L PLANK D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLANK
Provider First Name:
ROBIN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1174503437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 INNOVATION DRIVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SLIPPERY ROCK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16057-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-794-4023
Provider Business Mailing Address Fax Number:
724-794-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 INNOVATION DRIVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SLIPPERY ROCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16057-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-794-4023
Provider Business Practice Location Address Fax Number:
724-794-3675
Provider Enumeration Date:
01/20/2006

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:  OS010842L , 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)