1275676447 NPI number — MRS. KATHLEEN H MACFARLANE PHD

Table of content: DEBORAH SCANNELL WALDMAN AU.D. (NPI 1306984166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275676447 NPI number — MRS. KATHLEEN H MACFARLANE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACFARLANE
Provider First Name:
KATHLEEN
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHARLTON
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275676447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 LAKEVIEW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLINGSWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-858-1050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 HADDON AVENUE
Provider Second Line Business Practice Location Address:
OUR LADY OF LOURDES HOSPITAL REGIONAL REHABILITATION
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-757-3973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

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: 103T00000X , with the licence number:  35S100404300 , 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: 9057005 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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