1609841139 NPI number — DR. HUGO JAMES PFAEFFLE MD,PHD

Table of content: DR. HUGO JAMES PFAEFFLE MD,PHD (NPI 1609841139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609841139 NPI number — DR. HUGO JAMES PFAEFFLE MD,PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PFAEFFLE
Provider First Name:
HUGO
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,PHD
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:
1609841139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 BROOKTREE RD STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-9285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-367-0600
Provider Business Mailing Address Fax Number:
412-367-7079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6998 CRIDER RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MARS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16046-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-779-7000
Provider Business Practice Location Address Fax Number:
412-367-7079
Provider Enumeration Date:
02/20/2006

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: 174400000X , with the licence number:  MD425835 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: MD 425835 , 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: 1012525240002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012525240003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012525240004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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