1841592870 NPI number — DR. COURTNEY HUSTON CHELLEW DO

Table of content: DR. COURTNEY HUSTON CHELLEW DO (NPI 1841592870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841592870 NPI number — DR. COURTNEY HUSTON CHELLEW DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHELLEW
Provider First Name:
COURTNEY
Provider Middle Name:
HUSTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1841592870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1830
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18105-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-862-3193
Provider Business Mailing Address Fax Number:
484-664-7659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2545 SCHOENERSVILLE ROAD
Provider Second Line Business Practice Location Address:
LVH-M SOUTH 5TH FLOOR
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-884-6503
Provider Business Practice Location Address Fax Number:
484-884-6504
Provider Enumeration Date:
11/24/2010

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: 2084P0804X , with the licence number:  OS017530 , 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)