1659483139 NPI number — PAMELA S POTASH D. O.

Table of content: PAMELA S POTASH D. O. (NPI 1659483139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659483139 NPI number — PAMELA S POTASH D. O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTASH
Provider First Name:
PAMELA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D. O.
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:
1659483139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1251 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17003-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-867-4671
Provider Business Mailing Address Fax Number:
717-867-4981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17003-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-867-4671
Provider Business Practice Location Address Fax Number:
717-867-4981
Provider Enumeration Date:
08/31/2006

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: 207Q00000X , with the licence number:  0S009893L , 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: 7053141 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7053141 . This is a "USH/HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018076540001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00262035 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001807654 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50051245 . This is a "CAPITAL BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P002389 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 624163 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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