1184051294 NPI number — LISA MARIE ROBINHOLT PA-C

Table of content: LISA MARIE ROBINHOLT PA-C (NPI 1184051294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184051294 NPI number — LISA MARIE ROBINHOLT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINHOLT
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1184051294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 DOCK HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17842-8910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-837-2123
Provider Business Mailing Address Fax Number:
570-837-2185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 RIVER AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-329-4118
Provider Business Practice Location Address Fax Number:
570-326-5533
Provider Enumeration Date:
10/03/2013

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: 363A00000X , with the licence number:  MA056529 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: OA003169 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 319177F6K . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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