1205002698 NPI number — CARA LEA O'SHAUGHNESSEY D.O.

Table of content: CARA LEA O'SHAUGHNESSEY D.O. (NPI 1205002698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205002698 NPI number — CARA LEA O'SHAUGHNESSEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'SHAUGHNESSEY
Provider First Name:
CARA
Provider Middle Name:
LEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STREFF
Provider Other First Name:
CARA
Provider Other Middle Name:
LEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205002698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 SPRINGDALE DRIVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-561-6100
Provider Business Mailing Address Fax Number:
610-524-0133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 SPRINGDALE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341-2551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-561-6100
Provider Business Practice Location Address Fax Number:
610-524-0133
Provider Enumeration Date:
05/05/2008

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: 207R00000X , with the licence number:  OS015084 , 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: 102638094 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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