1144226655 NPI number — DR. JOHN EDER OD

Table of content: DR. JOHN EDER OD (NPI 1144226655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144226655 NPI number — DR. JOHN EDER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDER
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1144226655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2627 WEST CUMBERLAND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-272-3068
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2627 WEST CUMBERLAND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-272-3068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2005

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: 152W00000X , with the licence number:  OEG000495 , 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: 0004514752 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000038353 . This is a "FEDERAL EMPLOYEE PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000038353 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 038353 . This is a "HEALTHNOW (DMERC)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: U06674 . This is a "HEALTH AMERICA/ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: U06674 . This is a "HEALTHASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2000153 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 38081 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410040479 . This is a "PALMETTO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000038353 . This is a "CLARITY VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01433601 . This is a "CAPTIAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01433601 . This is a "NCAS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: U06674 . This is a "HEALTHGUARD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com