1427243245 NPI number — MYLAINA LYN SHERWOOD M.D.

Table of content: MYLAINA LYN SHERWOOD M.D. (NPI 1427243245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427243245 NPI number — MYLAINA LYN SHERWOOD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERWOOD
Provider First Name:
MYLAINA
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1427243245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 LEONARD AVE
Provider Second Line Business Mailing Address:
BLDG 2
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-3368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-223-3100
Provider Business Mailing Address Fax Number:
724-223-3353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3415 MILLERS RUN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CECIL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15321-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-873-7414
Provider Business Practice Location Address Fax Number:
724-873-7421
Provider Enumeration Date:
09/14/2007

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: 207Q00000X , with the licence number:  ML002805 , 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: P00754785 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1985059 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 730501 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1020140260004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 276599 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P010202 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com