1780654814 NPI number — MEDICAL HEALTH GROUP PA

Table of content: MRS. JASMINE AVIV DUNCKEL LMFT (NPI 1649438375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780654814 NPI number — MEDICAL HEALTH GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL HEALTH GROUP PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1780654814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1415 S MOUNTAIN RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPPA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21085-3236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-369-1699
Provider Business Mailing Address Fax Number:
410-369-1707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 S MOUNTAIN RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPPA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21085-3236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-369-1699
Provider Business Practice Location Address Fax Number:
410-369-1707
Provider Enumeration Date:
01/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOLCOTT
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
410-369-1700

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W647 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2977766006 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0291801 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".