1316008022 NPI number — DR. JARED M DUDDY D.C.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316008022 NPI number — DR. JARED M DUDDY D.C.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DUDDY

Provider First Name:

JARED

Provider Middle Name:

M

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.C.

Provider Gender Code:

M

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:

1316008022

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

645 E BUTLER AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NEW BRITAIN

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18901-5300

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

215-230-1999

Provider Business Mailing Address Fax Number:

215-230-0363

Provider First Line Business Practice Location Address:

645 E BUTLER AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

NEW BRITAIN

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18901-5300

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

215-230-1999

Provider Business Practice Location Address Fax Number:

215-230-0363

Provider Enumeration Date:

12/13/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 111N00000X , with the licence number:  DC007108L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 12047381 . This is a "MULTI PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 5020659 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0452630000 . This is a "IBC AHA KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P3244214 . This is a "OXFORD TRIAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: GEISSINGER HEALTH . This is a "101388" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 4501062 . This is a "GHI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1032227 . This is a "ASHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 5687279 . This is a "FIRST HEALTH CCN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 79152 . This is a "OPERATING ENGINEERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 5864360 . This is a "CBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 607153 . This is a "GREAT WEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2047440 . This is a "UNTIED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".