1336350487 NPI number — DR. SHELLEY MARGED WEBER PH.D., FPPR

Table of content: DR. SHELLEY MARGED WEBER PH.D., FPPR (NPI 1336350487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336350487 NPI number — DR. SHELLEY MARGED WEBER PH.D., FPPR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBER
Provider First Name:
SHELLEY
Provider Middle Name:
MARGED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., FPPR
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:
1336350487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PRINCETON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYN MAWR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19010-2119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-525-2022
Provider Business Mailing Address Fax Number:
610-964-8887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
987 OLD EAGLE SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 712
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-687-6008
Provider Business Practice Location Address Fax Number:
610-964-8887
Provider Enumeration Date:
05/24/2007

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: 103TP0016X , with the licence number:  PS-002925L , 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)





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