1326194648 NPI number — ROBERT WILLIAM CHILDS M.D.

Table of content: ROBERT WILLIAM CHILDS M.D. (NPI 1326194648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326194648 NPI number — ROBERT WILLIAM CHILDS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILDS
Provider First Name:
ROBERT
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1326194648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PEDIATRIC ASSOCIATES OF HAZLETON
Provider Second Line Business Mailing Address:
1000 ALLIANCE DRIVE
Provider Business Mailing Address City Name:
HAZLETON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18202-3234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-501-6400
Provider Business Mailing Address Fax Number:
570-453-2353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LEHIGH VALLEY PHYSICIAN BUSINESS SERVICES
Provider Second Line Business Practice Location Address:
1650 VALLEY CENTER PARKWAY, SUITE 100
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-884-4436
Provider Business Practice Location Address Fax Number:
484-884-7367
Provider Enumeration Date:
01/27/2007

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: 208000000X , with the licence number:  MD-014506-E , 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: 0005875560006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170494 . This is a "BLU CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 558825 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12004 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 003004 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P3287365 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 81001 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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