1548290927 NPI number — DR. SEAN M WALPOLE DPM

Table of content: DR. SEAN M WALPOLE DPM (NPI 1548290927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548290927 NPI number — DR. SEAN M WALPOLE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALPOLE
Provider First Name:
SEAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1548290927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 S OCTORARA TRL
Provider Second Line Business Mailing Address:
SUITE 160/170
Provider Business Mailing Address City Name:
PARKESBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19365-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-871-0851
Provider Business Mailing Address Fax Number:
610-857-6638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 S OCTORARA TRL
Provider Second Line Business Practice Location Address:
SUITE 160/170
Provider Business Practice Location Address City Name:
PARKESBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19365-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-871-0851
Provider Business Practice Location Address Fax Number:
610-857-6638
Provider Enumeration Date:
07/03/2006

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: 213E00000X , with the licence number:  SC004518L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: E10000157 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 50133623 . This is a "CBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000015486 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0335570001 . This is a "DMEPOS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0335570001 . This is a "DMEPOS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 101317084 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001419065 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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