1235274176 NPI number — MARVIN L PFLAUMER OD

Table of content: MARVIN L PFLAUMER OD (NPI 1235274176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235274176 NPI number — MARVIN L PFLAUMER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PFLAUMER
Provider First Name:
MARVIN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1235274176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N CHURCH ST
Provider Second Line Business Mailing Address:
P O BOX 417
Provider Business Mailing Address City Name:
NEW CARLISLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45344-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-845-9444
Provider Business Mailing Address Fax Number:
937-845-1151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CARLISLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45344-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-845-9444
Provider Business Practice Location Address Fax Number:
937-845-1151
Provider Enumeration Date:
02/20/2007

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: 152W00000X , with the licence number:  2835T598 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2220143 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311584763028 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 74386 . This is a "MOLINA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0092411 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000022407 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4638481 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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