1194887091 NPI number — SUSAN MARY MCCLAIN MPT, CERT. MDT

Table of content: SUSAN MARY MCCLAIN MPT, CERT. MDT (NPI 1194887091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194887091 NPI number — SUSAN MARY MCCLAIN MPT, CERT. MDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAIN
Provider First Name:
SUSAN
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT, CERT. MDT
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:
1194887091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3411 SILVERSIDE RD
Provider Second Line Business Mailing Address:
SUITE 105 SPRINGER BLDG
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-4812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-655-5877
Provider Business Mailing Address Fax Number:
302-655-0825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 BAYNARD BLVD
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19802-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-655-5877
Provider Business Practice Location Address Fax Number:
302-655-0825
Provider Enumeration Date:
12/15/2006

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: 225100000X , with the licence number:  J1-0000969 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT0009272L , 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)





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