1407134000 NPI number — RITA THERESA HARTY MS PA-C

Table of content: RITA THERESA HARTY MS PA-C (NPI 1407134000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407134000 NPI number — RITA THERESA HARTY MS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTY
Provider First Name:
RITA
Provider Middle Name:
THERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS PA-C
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:
1407134000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 COX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060-9263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-822-4355
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 ROUTE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08075-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-705-0685
Provider Business Practice Location Address Fax Number:
727-210-4600
Provider Enumeration Date:
07/30/2011

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: 363AM0700X , with the licence number:  25MP00204300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25MP00204300 . This is a "NJ LICENSE NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: PA 9109246 . This is a "PA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com