1740222413 NPI number — DR. PAMELA G MEHALICK DO

Table of content: DR. PAMELA G MEHALICK DO (NPI 1740222413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740222413 NPI number — DR. PAMELA G MEHALICK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHALICK
Provider First Name:
PAMELA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1740222413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 LIPPINCOTT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-4112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-782-3300
Provider Business Mailing Address Fax Number:
856-504-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BALDWIN TOWER
Provider Second Line Business Practice Location Address:
1510 CHESTER PIKE, SUITE 105
Provider Business Practice Location Address City Name:
EDDYSTONE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19022-1375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-485-2005
Provider Business Practice Location Address Fax Number:
484-485-2009
Provider Enumeration Date:
06/10/2006

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: 208000000X , with the licence number:  OS0048256L , 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)





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