1376563171 NPI number — DR. ALISON M MITCH MD

Table of content: DR. ALISON M MITCH MD (NPI 1376563171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376563171 NPI number — DR. ALISON M MITCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCH
Provider First Name:
ALISON
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1376563171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 CEDARWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-484-4068
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 BERK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19533-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-376-4841
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

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: 208100000X , with the licence number:  MD420898 , 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: 20033593 . This is a "AMERIHEALTH ADMINISTRATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50040136 . This is a "CAPITAL BLUE CROSS CAPITA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001491263 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2180795000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3000215 . This is a "KEYSTONE HEALTH PLAN CENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0019624550002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000172928 . This is a "THREE RIVERS UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20033593 . This is a "AMERIHEALTH MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2180795000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 352683 . This is a "HEALTH AMERICA HEALTH AS" identifier . This identifiers is of the category "OTHER".




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