1871595041 NPI number — STEPHEN M HUMBERT DO

Table of content: STEPHEN M HUMBERT DO (NPI 1871595041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871595041 NPI number — STEPHEN M HUMBERT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMBERT
Provider First Name:
STEPHEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1871595041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2510 W TOWNSHIP LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-450-4500
Provider Business Mailing Address Fax Number:
484-450-0575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 W TOWNSHIP LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-450-4500
Provider Business Practice Location Address Fax Number:
484-450-0575
Provider Enumeration Date:
06/01/2005

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: 207R00000X , with the licence number:  OS007256L , 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: 0014679730001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com