1194761015 NPI number — DOUGLAS A OCKRYMIEK DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194761015 NPI number — DOUGLAS A OCKRYMIEK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCKRYMIEK
Provider First Name:
DOUGLAS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1194761015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 HIGHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17554-1232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-285-7121
Provider Business Mailing Address Fax Number:
717-285-5302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 NEW HOLLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17602-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-390-0353
Provider Business Practice Location Address Fax Number:
717-390-1812
Provider Enumeration Date:
06/20/2006

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: 2084P0800X , with the licence number:  OS004324L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X , with the licence number: OS004324L , 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: 2095770 . This is a "CIGNA BEHAV HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 115435 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000957497 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50052373 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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