1093230500 NPI number — RETINA AND VITREOUS OF DELAWARE VALLEY, PC

Table of content: (NPI 1093230500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093230500 NPI number — RETINA AND VITREOUS OF DELAWARE VALLEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA AND VITREOUS OF DELAWARE VALLEY, 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:
1093230500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
491 BALTIMORE PIKE STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19064-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 E STREET RD STE 46
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19382-8412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-250-3937
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
855-250-3937

Provider Taxonomy Codes

  • Taxonomy code: 207WX0107X , with the licence number:  MD443007 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0107X , with the licence number: C1-0009712 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com