1174668768 NPI number — HARRY W BUCHANAN IV MD

Table of content: (NPI 1174668768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174668768 NPI number — HARRY W BUCHANAN IV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRY W BUCHANAN IV MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1174668768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 N 17TH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-5052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-433-2021
Provider Business Mailing Address Fax Number:
610-433-7856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-433-2021
Provider Business Practice Location Address Fax Number:
610-433-7856
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHANAN
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-433-2021

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , 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: 102862302 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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