1295963213 NPI number — LEA KATRIN HARMS MD

Table of content: LEA KATRIN HARMS MD (NPI 1295963213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295963213 NPI number — LEA KATRIN HARMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMS
Provider First Name:
LEA
Provider Middle Name:
KATRIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1295963213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 EOFF ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-3823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-234-8663
Provider Business Mailing Address Fax Number:
304-234-8960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 CHAPLINE ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-3859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-234-1610
Provider Business Practice Location Address Fax Number:
304-234-1739
Provider Enumeration Date:
06/29/2009

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: 207V00000X , with the licence number:  4301094835 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: 25582 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810026839 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0094606 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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