1508885153 NPI number — MARY ANN DEVINE M.D.

Table of content: ELLEN M WALTER CNP (NPI 1447340534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508885153 NPI number — MARY ANN DEVINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVINE
Provider First Name:
MARY ANN
Provider Middle Name:
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:
1508885153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-8721
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-734-0188
Provider Business Mailing Address Fax Number:
973-290-7495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 WHITEHORSE MERCERVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619-3835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-588-5081
Provider Business Practice Location Address Fax Number:
609-588-5086
Provider Enumeration Date:
07/18/2006

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: 207RC0200X , with the licence number:  MD050359L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: MD050359L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101138584-02 . This is a "AMERICHOICE FRANKFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34937 . This is a "HEALTH PARTNERS BUCKS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00286205 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101138584-01 . This is a "AMERICHOICE TORRESDALE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101138584-02 . This is a "AMERICHOICE BUCKS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011385840003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34935 . This is a "HEALTH PARTNERS TORRES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011385840002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1850152 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1128277 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2334986000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34936 . This is a "HEALTH PARTNERS FRANK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011385840001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30024403 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1658650 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1658650 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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