1376810135 NPI number — THE CENTER FOR BREAST HEALTH, P.C.

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 1376810135 NPI number — THE CENTER FOR BREAST HEALTH, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR BREAST HEALTH, P.C.
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:
1376810135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 STATE ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16507-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-836-8860
Provider Business Mailing Address Fax Number:
814-314-0057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16507-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-836-8860
Provider Business Practice Location Address Fax Number:
814-314-0057
Provider Enumeration Date:
11/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DUCHINI
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR SURGEON
Authorized Official Telephone Number:
814-836-8860

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  PA010803L , 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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