1437259710 NPI number — MRS. LINDA ANNE ULRICH M.S.

Table of content: MRS. LINDA ANNE ULRICH M.S. (NPI 1437259710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437259710 NPI number — MRS. LINDA ANNE ULRICH M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULRICH
Provider First Name:
LINDA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
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:
1437259710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 RIDGEWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOW GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19090-4327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-657-4815
Provider Business Mailing Address Fax Number:
215-332-1914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
205-207
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-332-1914
Provider Business Practice Location Address Fax Number:
215-332-1873
Provider Enumeration Date:
09/25/2006

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: 101YM0800X , with the licence number:  PS007190L , 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: 0873626000 . This is a "MAGELLAN ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5790198 . This is a "AETNA ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com