1114588837 NPI number — MONIKA KUSUMA PRINGLE MD

Table of content: MONIKA KUSUMA PRINGLE MD (NPI 1114588837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114588837 NPI number — MONIKA KUSUMA PRINGLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUSUMA PRINGLE
Provider First Name:
MONIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1114588837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1086 FRANKLIN STREET
Provider Second Line Business Mailing Address:
FAMILY MEDICAL CENTER
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-534-9106
Provider Business Mailing Address Fax Number:
814-534-3136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DLP CONEMAUGH MEMORIAL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
1020 FRANKLIN STREET SUITE 202
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-1722
Provider Business Practice Location Address Fax Number:
814-534-1814
Provider Enumeration Date:
06/24/2019

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: 207Q00000X , with the licence number:  MD483669 , 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)





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