1417990193 NPI number — BRYN MAWR FOOT & ANKLE CENTER, LLC

Table of content: DR. CONSTANCE B. SHARP PH.D. (NPI 1245497411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417990193 NPI number — BRYN MAWR FOOT & ANKLE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYN MAWR FOOT & ANKLE CENTER, LLC
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:
BRYN MAWR FOOT & ANKLE CENTER
Provider Other Organization Name Type Code:
4
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:
1417990193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
934 COUNTY LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYN MAWR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19010-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-527-8655
Provider Business Mailing Address Fax Number:
610-527-8346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
934 COUNTY LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-527-8655
Provider Business Practice Location Address Fax Number:
610-527-8346
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-527-8655

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC003800L , 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: 101657273 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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