1154424109 NPI number — MARCIA GUTOWICZ

Table of content: MARCIA GUTOWICZ (NPI 1154424109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154424109 NPI number — MARCIA GUTOWICZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTOWICZ
Provider First Name:
MARCIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1154424109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3871 DEMPSEY LN
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-471-1711
Provider Business Mailing Address Fax Number:
215-947-2593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 WELSH RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
HUNTINGDON VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19006-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-947-0153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006

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: 208600000X , with the licence number:  MD020794E , 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: 0045150000 . This is a "KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0105193503 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 181277 . This is a "BLUE SHIELD" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: P2020972 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0045150000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011551 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 55778 . This is a "USHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010519350006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10998 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com