1174797989 NPI number — TORAN DRUE MACLEOD PT

Table of content: TORAN DRUE MACLEOD PT (NPI 1174797989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174797989 NPI number — TORAN DRUE MACLEOD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACLEOD
Provider First Name:
TORAN
Provider Middle Name:
DRUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FURCH
Provider Other First Name:
TORAN
Provider Other Middle Name:
DRUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174797989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 BAYLOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19711-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 E DELAWARE AVE
Provider Second Line Business Practice Location Address:
053 MCKINLY LAB
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19716-3798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-831-8420
Provider Business Practice Location Address Fax Number:
302-831-4468
Provider Enumeration Date:
04/14/2008

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: 208100000X , with the licence number:  J1-0002337 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)