1255451027 NPI number — COMMONWEALTH PRIMARY CARE, PC

Table of content: KARIN ANNE FOWLER P.A. (NPI 1629022454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255451027 NPI number — COMMONWEALTH PRIMARY CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH PRIMARY CARE, PC
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:
6
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:
1255451027
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:
2 MERIDIAN BLVD
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-3202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-372-4957
Provider Business Mailing Address Fax Number:
610-372-3117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
346 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19547-8712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-987-9870
Provider Business Practice Location Address Fax Number:
610-987-0029
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNDT
Authorized Official First Name:
JODI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
610-372-4957

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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