1932253002 NPI number — PENN MEDICAL GROUP, P.C.

Table of content: (NPI 1932253002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932253002 NPI number — PENN MEDICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN MEDICAL GROUP, P.C.
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:
1932253002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 N KROCKS RD STE 101A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18106-9075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-365-3354
Provider Business Mailing Address Fax Number:
610-365-3361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 N KROCKS RD STE 101A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18106-9075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-365-3354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BADDICK
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER, EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
570-386-4171

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1215993928 . This is a "DR. BADDICK NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015989840002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019475840006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629038468 . This is a "DR. OGBOLU NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".