1194788083 NPI number — DR. DAPHNE P BICKET MD

Table of content: DR. DAPHNE P BICKET MD (NPI 1194788083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194788083 NPI number — DR. DAPHNE P BICKET MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BICKET
Provider First Name:
DAPHNE
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1194788083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 ARDMORE BLVD. STE 700
Provider Second Line Business Mailing Address:
PITTSBURGH CARE PARTNERSHIP INC.
Provider Business Mailing Address City Name:
PGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-436-1341
Provider Business Mailing Address Fax Number:
412-436-1322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 MEADE ST
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:
15221-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-436-1298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2006

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: 174400000X , with the licence number:  MD058307L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD058307L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD058307-L , 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: DPAO1613955 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161395500 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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