1003892589 NPI number — GEORGE CAPELLA GARROW MD

Table of content: KRISTINE RENEE' LEWIS PA-C (NPI 1598746547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003892589 NPI number — GEORGE CAPELLA GARROW MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARROW
Provider First Name:
GEORGE
Provider Middle Name:
CAPELLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1003892589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SHENANGO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16146-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-342-3002
Provider Business Mailing Address Fax Number:
724-342-1942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 PITT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16146-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-342-6604
Provider Business Practice Location Address Fax Number:
724-342-1601
Provider Enumeration Date:
12/16/2005

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: 207RX0202X , with the licence number:  MD072681L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD072681L , 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: 0018248240011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240036 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240044 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240046 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240047 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240049 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240039 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240022 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240028 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240029 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240042 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240045 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018248240017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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