1336440700 NPI number — LANKENAU MEDICAL CENTER

Table of content: (NPI 1336440700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336440700 NPI number — LANKENAU MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANKENAU MEDICAL CENTER
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:
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:
1336440700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 SHARPLESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19382-3541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-692-0754
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 418 LANKENAU MEDICAL CENTER
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-476-8464
Provider Business Practice Location Address Fax Number:
484-476-1626
Provider Enumeration Date:
11/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MORTON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
ALFRED
Authorized Official Title or Position:
PHYSICIAN ASSISTANT
Authorized Official Telephone Number:
610-692-0754

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  MA000079L , 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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