1821265943 NPI number — WEST DERMATOLOGY OF PENNSYLVANIA A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1821265943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821265943 NPI number — WEST DERMATOLOGY OF PENNSYLVANIA A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST DERMATOLOGY OF PENNSYLVANIA A PROFESSIONAL MEDICAL CORPORATION
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:
J. ROBERT WEST, M.D., INC
Provider Other Organization Name Type Code:
5
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:
1821265943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2199
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-0721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-335-8649
Provider Business Mailing Address Fax Number:
909-557-1953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 W BEAU ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-225-1505
Provider Business Practice Location Address Fax Number:
724-225-5810
Provider Enumeration Date:
05/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-335-8649

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD432414 , 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: MD432414 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DN4267 . This is a "RAILROAD MEDICARE WEST DERM OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RU2030643 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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