1639277700 NPI number — DR. AMA D GRAHAM-KREMERS DDS

Table of content: DR. AMA D GRAHAM-KREMERS DDS (NPI 1639277700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639277700 NPI number — DR. AMA D GRAHAM-KREMERS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAHAM-KREMERS
Provider First Name:
AMA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1639277700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N HANOVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-218-6670
Provider Business Mailing Address Fax Number:
717-218-6671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N HANOVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-218-6670
Provider Business Practice Location Address Fax Number:
717-218-6671
Provider Enumeration Date:
09/20/2006

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: 122300000X , with the licence number:  DS036878 , 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: 1007543070048 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007543070009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017665810014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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