1760720072 NPI number — PAMELA JAYNE ZIEGLER PA-C

Table of content: PAMELA JAYNE ZIEGLER PA-C (NPI 1760720072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760720072 NPI number — PAMELA JAYNE ZIEGLER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIEGLER
Provider First Name:
PAMELA
Provider Middle Name:
JAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASSIDY
Provider Other First Name:
PAMELA
Provider Other Middle Name:
JAYNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760720072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 SPRUCE ST
Provider Second Line Business Mailing Address:
4 SILVERSTEIN
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-4206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-662-2626
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 SPRUCE ST
Provider Second Line Business Practice Location Address:
4 SILVERSTEIN
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-2626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2013

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: 363AM0700X , with the licence number:  MA055738 , 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)