1336273184 NPI number — ALLEN C RICHMOND MD PC

Table of content: (NPI 1336273184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336273184 NPI number — ALLEN C RICHMOND MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEN C RICHMOND MD PC
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:
1336273184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3998 RED LION RD
Provider Second Line Business Mailing Address:
302
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19114-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-824-1717
Provider Business Mailing Address Fax Number:
215-281-0759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 RED LION RD
Provider Second Line Business Practice Location Address:
302
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-824-1717
Provider Business Practice Location Address Fax Number:
215-281-0759
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHMOND
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
OPHTHALMOLOGIST
Authorized Official Telephone Number:
215-824-1717

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1029401 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006169250001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3341 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3430693000 . This is a "KEYSTONE/PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 072502 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 19131 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DG8566 . This is a "PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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