1336140599 NPI number — DR. CHARLES T GIVENS M.D,

Table of content: DR. CHARLES T GIVENS M.D, (NPI 1336140599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336140599 NPI number — DR. CHARLES T GIVENS M.D,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIVENS
Provider First Name:
CHARLES
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
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:
1336140599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4885 DEMOSS RD
Provider Second Line Business Mailing Address:
SUITE201
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19606-9023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-779-9489
Provider Business Mailing Address Fax Number:
610-779-9487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4885 DE MOSS RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19606-0309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-779-9489
Provider Business Practice Location Address Fax Number:
610-779-9487
Provider Enumeration Date:
08/09/2005

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: 207Q00000X , with the licence number:  MD067615L , 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: 001818522 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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