1528243300 NPI number — DR. CHARISSE JANET WARD MD, MPH

Table of content: DR. CHARISSE JANET WARD MD, MPH (NPI 1528243300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528243300 NPI number — DR. CHARISSE JANET WARD MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
CHARISSE
Provider Middle Name:
JANET
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1528243300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
367 S GULPH RD, ATN :IPM CREDENTIALING
Provider Second Line Business Mailing Address:
ATN :IPM CREDENTIALING
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-297-5166
Provider Business Mailing Address Fax Number:
580-237-1340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 GAUSE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-641-7577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2007

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: 207RC0000X , with the licence number:  306659 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: Q9078 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 38234 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 306659 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200985520A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100233521 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1Q0274 . This is a "PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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