1891875456 NPI number — BUXMONT MEDICAL ASSOCIATES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891875456 NPI number — BUXMONT MEDICAL ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUXMONT MEDICAL ASSOCIATES, PC
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:
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:
1891875456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
847 EASTON RD
Provider Second Line Business Mailing Address:
SUITE 2500
Provider Business Mailing Address City Name:
WARRINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18976-2907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-918-5555
Provider Business Mailing Address Fax Number:
215-918-5560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
847 EASTON RD
Provider Second Line Business Practice Location Address:
SUITE 2500
Provider Business Practice Location Address City Name:
WARRINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18976-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-918-5555
Provider Business Practice Location Address Fax Number:
215-918-5560
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANDEL
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
215-918-5555

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 139172 . This is a "AETNA GROUP ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1462206 . This is a "HIGHMARK BLUE SHIELD #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2151562001 . This is a "KEYSTONE HEALTHPLAN GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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