1225020688 NPI number — KERI MARIE LAVIGNE-LANGENSTEIN MD

Table of content: KERI MARIE LAVIGNE-LANGENSTEIN MD (NPI 1225020688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225020688 NPI number — KERI MARIE LAVIGNE-LANGENSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVIGNE-LANGENSTEIN
Provider First Name:
KERI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1225020688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602
Provider Second Line Business Mailing Address:
MARC J MEDWAY MD PC
Provider Business Mailing Address City Name:
GWYNEDD VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19437-0602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-542-7260
Provider Business Mailing Address Fax Number:
215-542-1012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 CENTRAL AVE
Provider Second Line Business Practice Location Address:
MARC J MEDWAY MD PC
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-728-3736
Provider Business Practice Location Address Fax Number:
215-728-3354
Provider Enumeration Date:
08/22/2005

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: 208100000X , with the licence number:  MD058349L , 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: 1122995 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2Y1545 . This is a "PHS HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2438725 . This is a "AETNA US HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01588594 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0961554000 . This is a "KEYSTONE HEALTH AMER HEAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 157681MD058349L . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com