1780684845 NPI number — DR. DEBORAH MARKIEWICZ MD

Table of content: DR. DEBORAH MARKIEWICZ MD (NPI 1780684845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780684845 NPI number — DR. DEBORAH MARKIEWICZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKIEWICZ
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1780684845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020A E BOAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOALSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16827-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-237-8627
Provider Business Mailing Address Fax Number:
814-238-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DREXEL HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19026-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-284-8240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2005

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: 2085R0001X , with the licence number:  MD040605E , 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: 0491927 . This is a "AETNA USHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014104980007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0638331000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1005825 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1920058 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 734460 . This is a "PA BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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