1780601112 NPI number — SHINETTE SIRMANS-MCRAE M.D.

Table of content: SHINETTE SIRMANS-MCRAE M.D. (NPI 1780601112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780601112 NPI number — SHINETTE SIRMANS-MCRAE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIRMANS-MCRAE
Provider First Name:
SHINETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIRMANS
Provider Other First Name:
SHINETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780601112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 BLOSSOM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EWING
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08638-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-912-0180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 CAMPUS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTOWN SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19073-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-454-6262
Provider Business Practice Location Address Fax Number:
610-789-6158
Provider Enumeration Date:
07/15/2006

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: 207R00000X , with the licence number:  25MA07699300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2022245 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3436078000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101902511 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30060749 . This is a "KEYSTONE MERCY-LOWER BUCKS GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com