1295947141 NPI number — RAYMOND KHOUDARY MDPC

Table of content: (NPI 1295947141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295947141 NPI number — RAYMOND KHOUDARY MDPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYMOND KHOUDARY MDPC
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:
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:
1295947141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 S RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18705-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-970-1400
Provider Business Mailing Address Fax Number:
570-970-1403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 S RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18705-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-970-1400
Provider Business Practice Location Address Fax Number:
570-970-1403
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING OFFICE
Authorized Official Telephone Number:
570-970-1400

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X , with the licence number:  MD048279L , 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)

  • Identifier: 8954255 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 020260900 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4557012 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50044349 . This is a "CBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 079698 . This is a "FPH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 333056 . This is a "HBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0031149000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 23578 . This is a "GHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com