1205986379 NPI number — OXFORD VALLEY VEIN & LASER CENTER

Table of content: (NPI 1205986379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205986379 NPI number — OXFORD VALLEY VEIN & LASER CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD VALLEY VEIN & LASER CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205986379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 BLANCOYD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERION STATION
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19066-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-664-4972
Provider Business Mailing Address Fax Number:
610-664-4972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 MIDDLETOWN BLVD
Provider Second Line Business Practice Location Address:
SUITE 508
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-741-4034
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEATTY
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-664-4972

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  MD005567E , 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)





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