1174821243 NPI number — MR. ADEL ABDELMASSIH BOTROS RP.H

Table of content: MR. ADEL ABDELMASSIH BOTROS RP.H (NPI 1174821243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174821243 NPI number — MR. ADEL ABDELMASSIH BOTROS RP.H

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOTROS
Provider First Name:
ADEL
Provider Middle Name:
ABDELMASSIH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RP.H
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:
1174821243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 ORCHARD HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMYRA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17078-8618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-832-3131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 CUMBERLAND ST
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:
17042-5150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-273-2281
Provider Business Practice Location Address Fax Number:
717-272-4160
Provider Enumeration Date:
03/14/2011

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: 183500000X , with the licence number:  RP042738L , 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)





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