1023485612 NPI number — DR. MARIA LINA THARP FLETCHER D.M.D

Table of content: DR. MARIA LINA THARP FLETCHER D.M.D (NPI 1023485612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023485612 NPI number — DR. MARIA LINA THARP FLETCHER D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
MARIA
Provider Middle Name:
LINA THARP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D
Provider Gender Code:
F

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:
1023485612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 S GEORGE ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17401-1474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-801-4821
Provider Business Mailing Address Fax Number:
717-854-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 S GEORGE ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17401-1474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-801-4821
Provider Business Practice Location Address Fax Number:
717-854-0377
Provider Enumeration Date:
08/31/2015

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: 122300000X , with the licence number:  DS040463 , 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: 1030632210002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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