1669955175 NPI number — MRS. MICHELLE COURTNEY PENDEL RD, LDN, CSSD

Table of content: MRS. MICHELLE COURTNEY PENDEL RD, LDN, CSSD (NPI 1669955175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669955175 NPI number — MRS. MICHELLE COURTNEY PENDEL RD, LDN, CSSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENDEL
Provider First Name:
MICHELLE
Provider Middle Name:
COURTNEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN, CSSD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAGREE
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
COURTNEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LDN, CSSD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669955175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5750 BAUM BLVD # 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15206-3793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-593-2048
Provider Business Mailing Address Fax Number:
844-311-7396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 ROBINSON PLZ # 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15205-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-593-2048
Provider Business Practice Location Address Fax Number:
844-311-7396
Provider Enumeration Date:
09/11/2018

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: 133V00000X , with the licence number:  DN004925 , 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: 1039241240001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".