1902882541 NPI number — MARY DHAND MD

Table of content: MARY DHAND MD (NPI 1902882541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902882541 NPI number — MARY DHAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHAND
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAVULA
Provider Other First Name:
MARY
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902882541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 HENRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19129-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-842-7415
Provider Business Mailing Address Fax Number:
215-848-1355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 HENRY AVE
Provider Second Line Business Practice Location Address:
ONE FALLS CENTER
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19129-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-842-7415
Provider Business Practice Location Address Fax Number:
215-848-1355
Provider Enumeration Date:
12/15/2005

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: 208000000X , with the licence number:  MD021505E , 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: 5839038 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9799707 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001613919 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0161391904 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 431154 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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