1184098246 NPI number — MRS. CHAUNTEL JOYCE DITOMMASO PA

Table of content: MRS. CHAUNTEL JOYCE DITOMMASO PA (NPI 1184098246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184098246 NPI number — MRS. CHAUNTEL JOYCE DITOMMASO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DITOMMASO
Provider First Name:
CHAUNTEL
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHANNON
Provider Other First Name:
CHAUNTEL
Provider Other Middle Name:
JOYCE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184098246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 BRAYDAN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75462-5902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-795-4622
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 E JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74743-4229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-326-6423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2015

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: 363A00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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