1336110923 NPI number — THOMAS E MACKELL MD LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336110923 NPI number — THOMAS E MACKELL MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS E MACKELL MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1336110923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/01/2008
NPI Reactivation Date:
11/03/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W STATE ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901-5842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-348-3068
Provider Business Mailing Address Fax Number:
215-348-7428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
847 EASTON RD
Provider Second Line Business Practice Location Address:
SUITE 2750
Provider Business Practice Location Address City Name:
WARRINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-918-5600
Provider Business Practice Location Address Fax Number:
215-918-5603
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACKELL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
215-348-3068

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111202 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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