1972514552 NPI number — E JOSEPH DENHAM D.O.

Table of content: E JOSEPH DENHAM D.O. (NPI 1972514552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972514552 NPI number — E JOSEPH DENHAM D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENHAM
Provider First Name:
E
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENHAM
Provider Other First Name:
EDWARD
Provider Other Middle Name:
JOSEPH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972514552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E PENN SQ
Provider Second Line Business Mailing Address:
THE WANAMAKER BUILDING, 9TH FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-425-9300
Provider Business Mailing Address Fax Number:
267-425-9331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34TH STREET & CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 9329
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-1858
Provider Business Practice Location Address Fax Number:
215-590-1415
Provider Enumeration Date:
08/10/2006

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: 207L00000X , with the licence number:  OS008223L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X , with the licence number: OS008223L , 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: 869484EJL . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016329500 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".