1447403431 NPI number — KARON MARTYN CRNP

Table of content: KARON MARTYN CRNP (NPI 1447403431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447403431 NPI number — KARON MARTYN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTYN
Provider First Name:
KARON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANADAY
Provider Other First Name:
KARYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447403431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 OLD YORK RD
Provider Second Line Business Mailing Address:
1 WIDENER
Provider Business Mailing Address City Name:
ABINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19001-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-481-2400
Provider Business Mailing Address Fax Number:
215-481-7438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 OLD YORK RD
Provider Second Line Business Practice Location Address:
1 WIDENER
Provider Business Practice Location Address City Name:
ABINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19001-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-481-2400
Provider Business Practice Location Address Fax Number:
215-481-7438
Provider Enumeration Date:
11/04/2008

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: 163WX0200X , with the licence number:  RN522924L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: SP009988 , 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: 102384911 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".