1285059881 NPI number — MEGHAN MICHELLE HATTERSLEY

Table of content: MEGHAN MICHELLE HATTERSLEY (NPI 1285059881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285059881 NPI number — MEGHAN MICHELLE HATTERSLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATTERSLEY
Provider First Name:
MEGHAN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KANE
Provider Other First Name:
MEGHAN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285059881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1806 SWAMP PIKE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19525-9307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-948-2800
Provider Business Mailing Address Fax Number:
610-792-3044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 W LINFIELD TRAPPE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMERICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19468-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-948-2800
Provider Business Practice Location Address Fax Number:
610-792-3044
Provider Enumeration Date:
02/19/2014

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: 225100000X , with the licence number:  PT023410 , 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)