1811006646 NPI number — DR. MARY PEARL GREISS-COULT D.O.

Table of content: DR. MARY PEARL GREISS-COULT D.O. (NPI 1811006646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811006646 NPI number — DR. MARY PEARL GREISS-COULT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREISS-COULT
Provider First Name:
MARY
Provider Middle Name:
PEARL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1811006646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611 POND RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-2258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-366-7444
Provider Business Mailing Address Fax Number:
610-366-0884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 POND RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-2258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-366-7444
Provider Business Practice Location Address Fax Number:
888-546-4216
Provider Enumeration Date:
08/29/2006

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: 207V00000X , with the licence number:  OS012199 , 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: 2828475000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2634499 . This is a "SOLO- HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3840818000 . This is a "SOLO- INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7763855 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1951168 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1902192917 . This is a "SOLO- HEALTH ASSURANCE/ HEALTH AMERICA/ COVENTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30101360 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1018461090001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26895627 . This is a "SOLO- UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30101359 . This is a "SOLO- AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1026436200001 . This is a "SOLO- MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4152777 . This is a "SOLO- CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50101951 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1811006646 . This is a "HEALTH ASSURANCE/ HEALTH AMERICA/ COVENTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50101952 . This is a "SOLO- CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9634726 . This is a "SOLO- AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 224848 . This is a "SOLO- MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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