1366433823 NPI number — JERZY K MAGDA MD

Table of content: JERZY K MAGDA MD (NPI 1366433823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366433823 NPI number — JERZY K MAGDA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGDA
Provider First Name:
JERZY
Provider Middle Name:
K
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:
1366433823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 ENCLAVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16105-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-658-6656
Provider Business Mailing Address Fax Number:
724-658-6542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 ENCLAVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-658-6656
Provider Business Practice Location Address Fax Number:
724-658-6542
Provider Enumeration Date:
11/03/2005

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:  MD049115L , 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: 051968 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 110219074 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1798653 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 134142 . This is a "HEALTH AMERICA HEALTH AS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 204703 . This is a "UPMC FOR YOU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2133166 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 204703 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2468537/001 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 69230 . This is a "THREE RIVERS MED PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P001100 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014237090004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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