1366409872 NPI number — DR. ANNE-MARIE LABERGE MD MSC BCEM

Table of content: DR. ANNE-MARIE LABERGE MD MSC BCEM (NPI 1366409872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366409872 NPI number — DR. ANNE-MARIE LABERGE MD MSC BCEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABERGE
Provider First Name:
ANNE-MARIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD MSC BCEM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLERMONT
Provider Other First Name:
ANNE-MARIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366409872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 951806
Provider Second Line Business Mailing Address:
ELLWOOD EMERGENCY PHYSICIANS INC
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-666-2455
Provider Business Mailing Address Fax Number:
610-660-9384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 PERSHING ST
Provider Second Line Business Practice Location Address:
ELLWOOD CITY HOSPITAL
Provider Business Practice Location Address City Name:
ELLWOOD CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-752-6744
Provider Business Practice Location Address Fax Number:
610-617-6280
Provider Enumeration Date:
04/27/2006

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: 207P00000X , with the licence number:  MD052139L , 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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