1285663187 NPI number — ROSS D PODELL MD

Table of content: ROSS D PODELL MD (NPI 1285663187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285663187 NPI number — ROSS D PODELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PODELL
Provider First Name:
ROSS
Provider Middle Name:
D
Provider Name Prefix Text:
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:
1285663187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 WEST LANCASTER AVENUE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301-1751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-889-7530
Provider Business Mailing Address Fax Number:
610-889-7531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 WEST LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301-1751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-889-7530
Provider Business Practice Location Address Fax Number:
610-889-7531
Provider Enumeration Date:
07/02/2006

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: 207R00000X , with the licence number:  MD 066922L , 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: 276714 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2008792001 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 261296 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0565534000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 110227133 . This is a "RR MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8118648004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133024 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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