1932177813 NPI number — THELMA LUFTMAN HERLICH MD

Table of content: MORGAN LANGE (NPI 1306683586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932177813 NPI number — THELMA LUFTMAN HERLICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERLICH
Provider First Name:
THELMA
Provider Middle Name:
LUFTMAN
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:
LUFTMAN
Provider Other First Name:
THELMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932177813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 MOUNT LEBANON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15234-1243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-561-7541
Provider Business Mailing Address Fax Number:
412-561-2366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MOUNT LEBANON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15234-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-561-7541
Provider Business Practice Location Address Fax Number:
412-561-2366
Provider Enumeration Date:
03/08/2006

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: 208000000X , with the licence number:  MD041500E , 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: 0011513690006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 555731 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".