1417910589 NPI number — ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF CHESTER COUNTY, LTD.

Table of content: MR. ALEXANDER LUCAH MOSTOVYCH MD (NPI 1063115111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417910589 NPI number — ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF CHESTER COUNTY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF CHESTER COUNTY, 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:
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:
1417910589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 E MARSHALL ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-4441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-431-2161
Provider Business Mailing Address Fax Number:
610-431-2173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E MARSHALL ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-431-2161
Provider Business Practice Location Address Fax Number:
610-431-2173
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
610-431-2161

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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