1912951989 NPI number — CARDIOTHORACIC SURGEONS OF LANCASTER, PC

Table of content: JODI ELIZABETH DRYER LPC (NPI 1699134353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912951989 NPI number — CARDIOTHORACIC SURGEONS OF LANCASTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOTHORACIC SURGEONS OF LANCASTER, 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:
1912951989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N DUKE ST
Provider Second Line Business Mailing Address:
BOX 3555
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17602-2250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-544-4995
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N DUKE ST
Provider Second Line Business Practice Location Address:
BOX 3555
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17602-2250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-544-4995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAUBACH
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
717-544-4995

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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