1003017534 NPI number — ROY M LERMAN MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003017534 NPI number — ROY M LERMAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROY M LERMAN MD 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:
6
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:
1003017534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 S HENDERSON RD
Provider Second Line Business Mailing Address:
STE 308C
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-337-3111
Provider Business Mailing Address Fax Number:
610-337-3506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 S HENDERSON RD
Provider Second Line Business Practice Location Address:
STE 300A
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-337-0427
Provider Business Practice Location Address Fax Number:
610-337-3506
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LERMAN
Authorized Official First Name:
ROY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
610-337-3111

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 777323 . This is a "BLUE SHIELD HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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