1043254410 NPI number — WHITE OAK OB GYN SERVICES PC

Table of content: (NPI 1043254410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043254410 NPI number — WHITE OAK OB GYN SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE OAK OB GYN SERVICES 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:
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:
1043254410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1966 LINCOLN WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WHITE OAK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15131-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-673-3800
Provider Business Mailing Address Fax Number:
412-673-5848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1966 LINCOLN WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WHITE OAK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15131-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-673-3800
Provider Business Practice Location Address Fax Number:
412-673-5848
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FULCINITI
Authorized Official First Name:
ROCCO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSCIAN
Authorized Official Telephone Number:
412-673-3800

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  016883E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207VX0000X , with the licence number: 016883E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0678042 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528035 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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