1154318277 NPI number — DR. ROBYN MIA SHOR-CONROY D.O.

Table of content: DR. ROBYN MIA SHOR-CONROY D.O. (NPI 1154318277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154318277 NPI number — DR. ROBYN MIA SHOR-CONROY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOR-CONROY
Provider First Name:
ROBYN
Provider Middle Name:
MIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1154318277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W SPROUL RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19064-2033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-338-1800
Provider Business Mailing Address Fax Number:
610-338-1809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W SPROUL ROAD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-338-1800
Provider Business Practice Location Address Fax Number:
610-338-1809
Provider Enumeration Date:
10/04/2005

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: 207Q00000X , with the licence number:  OS009580L , 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: 2201032 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA 1311 . This is a "BLUE SHIELD DELAWARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 83840000 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P0021899 . This is a "PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2168090 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 259354 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3Y3407 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G666844 . This is a "ELDER CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1328925 . This is a "MAILHANDLERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0773629000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 787975 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G87975 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P2799391 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA3532 . This is a "QUALMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2066531 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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