1154585909 NPI number — DR. ELIZABETH J CARDINALE MD

Table of content: DR. ELIZABETH J CARDINALE MD (NPI 1154585909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154585909 NPI number — DR. ELIZABETH J CARDINALE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDINALE
Provider First Name:
ELIZABETH
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1154585909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 STUDENT HEALTH CENTER
Provider Second Line Business Mailing Address:
UNIVERSITY HEALTH SERVICES
Provider Business Mailing Address City Name:
UNIVERSITY PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-863-2058
Provider Business Mailing Address Fax Number:
734-936-3063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 STUDENT HEALTH CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16802-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-865-4847
Provider Business Practice Location Address Fax Number:
814-865-7778
Provider Enumeration Date:
07/10/2008

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: 207R00000X , with the licence number:  4301097678 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A98038 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD474463 , 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: MD474463 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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