1649483678 NPI number — DR. LEE G DANTE MD

Table of content: DR. LEE G DANTE MD (NPI 1649483678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649483678 NPI number — DR. LEE G DANTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANTE
Provider First Name:
LEE
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1649483678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 BERKELEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERION STATION
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19066-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-667-5448
Provider Business Mailing Address Fax Number:
610-667-8117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 BERKELEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERION STATION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19066-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-667-5448
Provider Business Practice Location Address Fax Number:
610-667-8117
Provider Enumeration Date:
05/07/2007

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: 2084P0800X , with the licence number:  MD014206E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: D29330 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MD014206E . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: D29330 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 297501700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35415502 . This is a "BC BS PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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