1306147509 NPI number — MRS. NICOLE MARIE RHOADS RD, LDN

Table of content: MRS. NICOLE MARIE RHOADS RD, LDN (NPI 1306147509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306147509 NPI number — MRS. NICOLE MARIE RHOADS RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOADS
Provider First Name:
NICOLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENUSA
Provider Other First Name:
NICOLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306147509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 BERNVILLE ROAD (ROUTE 183)
Provider Second Line Business Mailing Address:
ST. JOSEPH MEDICAL CENTER
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-378-2487
Provider Business Mailing Address Fax Number:
610-378-2178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 N. 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19603-0316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-378-2100
Provider Business Practice Location Address Fax Number:
610-208-4775
Provider Enumeration Date:
11/04/2010

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: 133V00000X , with the licence number:  DN003619 , 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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