1902885296 NPI number — DR. ROEL D COMPENDIO MD

Table of content: DR. ROEL D COMPENDIO MD (NPI 1902885296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902885296 NPI number — DR. ROEL D COMPENDIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMPENDIO
Provider First Name:
ROEL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1902885296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MALIN STATION RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19035-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-240-0240
Provider Business Mailing Address Fax Number:
610-240-0335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-240-0240
Provider Business Practice Location Address Fax Number:
610-240-0335
Provider Enumeration Date:
01/13/2006

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: 2084P0800X , with the licence number:  MD063208L , 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: G81296 . This identifiers is of the category "MEDICARE UPIN".
  • Identifier: 020415P0T , issued by the state of ( PA ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".