1265649263 NPI number — LEA FLANAGAN MSPT

Table of content: LEA FLANAGAN MSPT (NPI 1265649263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265649263 NPI number — LEA FLANAGAN MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANAGAN
Provider First Name:
LEA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1265649263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 E CITY AVE
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-1730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-668-4055
Provider Business Mailing Address Fax Number:
610-668-4250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 YORKLYN RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
HOCKESSIN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19707-8728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-234-2288
Provider Business Practice Location Address Fax Number:
302-234-2869
Provider Enumeration Date:
05/17/2007

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:  PT014018L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: J1-00001567 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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