1255336715 NPI number — DR. CHARLES DINERSTEIN MD

Table of content: DR. CHARLES DINERSTEIN MD (NPI 1255336715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255336715 NPI number — DR. CHARLES DINERSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINERSTEIN
Provider First Name:
CHARLES
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255336715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17042-0300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-270-7780
Provider Business Mailing Address Fax Number:
717-274-9746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4TH & WALNUT STREETS
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-6123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-270-3751
Provider Business Practice Location Address Fax Number:
270-270-3754
Provider Enumeration Date:
06/20/2005

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: 2086S0129X , with the licence number:  MA048088 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102760804001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3967000 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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