1184624868 NPI number — MS. MARSHA ELLEN BERGER GRANT MS PT OCJ

Table of content: MS. MARSHA ELLEN BERGER GRANT MS PT OCJ (NPI 1184624868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184624868 NPI number — MS. MARSHA ELLEN BERGER GRANT MS PT OCJ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGER GRANT
Provider First Name:
MARSHA
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT OCJ
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:
1184624868
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:
676 DE KALB PIKE
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
BLUE BELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19422-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-270-0380
Provider Business Mailing Address Fax Number:
610-270-0874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 HORIZON DR
Provider Second Line Business Practice Location Address:
STE 102E
Provider Business Practice Location Address City Name:
CHALFONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18914-3966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-712-0300
Provider Business Practice Location Address Fax Number:
215-712-9040
Provider Enumeration Date:
07/26/2005

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: 225100000X , with the licence number:  PT005482L , 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)





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