1215920335 NPI number — DR. ANDREW LEE MERMELSTEIN MD

Table of content: MICHELLE UYEDA (NPI 1386516615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215920335 NPI number — DR. ANDREW LEE MERMELSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERMELSTEIN
Provider First Name:
ANDREW
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1215920335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 W GERMANTOWN PIKE
Provider Second Line Business Mailing Address:
SUITE C-2
Provider Business Mailing Address City Name:
EAST NORRITON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19401-1389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-277-2750
Provider Business Mailing Address Fax Number:
610-277-7949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 W. GERMANTOWN PIKE
Provider Second Line Business Practice Location Address:
SUITE C-2
Provider Business Practice Location Address City Name:
EAST NORRITON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-1389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-277-2750
Provider Business Practice Location Address Fax Number:
610-277-7949
Provider Enumeration Date:
08/24/2005

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: 207RR0500X , with the licence number:  MD061891L , 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: 960047 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0416013000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2584 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0416013000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com