1194724807 NPI number — DR. PAUL J HOOLAHAN O.D.

Table of content: DR. PAUL J HOOLAHAN O.D. (NPI 1194724807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194724807 NPI number — DR. PAUL J HOOLAHAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOLAHAN
Provider First Name:
PAUL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1194724807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 CEDAR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15212-4812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-321-3444
Provider Business Mailing Address Fax Number:
412-466-7906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 CEDAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15212-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-321-3444
Provider Business Practice Location Address Fax Number:
412-466-7906
Provider Enumeration Date:
07/15/2005

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: 152W00000X , with the licence number:  OEG000666 , 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: 0010996610008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 301834 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4389392 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 500418 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50539000 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7137896 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1194724807 . This is a "OPTICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: H0500418 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000500418 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 236729 . This is a "ADVANTRA/ HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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