1467924381 NPI number — DEVELOPMENTAL INTEGRATIVE PEDIATRICS

Table of content: (NPI 1467924381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467924381 NPI number — DEVELOPMENTAL INTEGRATIVE PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENTAL INTEGRATIVE PEDIATRICS
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:
1467924381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 791
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARNEGIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15106-0791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
141-265-5436
Provider Business Mailing Address Fax Number:
412-653-7684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 ABELE RD STE 1105A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15017-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-221-0800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BILLINGS
Authorized Official First Name:
KRISTYN
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE DEPT
Authorized Official Telephone Number:
412-655-4362

Provider Taxonomy Codes

  • Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD065544L . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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