1427054972 NPI number — KIMBERLY A. CAVANAGH P.A. - C.

Table of content: KIMBERLY A. CAVANAGH P.A. - C. (NPI 1427054972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427054972 NPI number — KIMBERLY A. CAVANAGH P.A. - C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVANAGH
Provider First Name:
KIMBERLY
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A. - 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:
1427054972
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:
120 E. 2ND STREET
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16507-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-456-8980
Provider Business Mailing Address Fax Number:
814-451-0443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E. 2ND STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16507-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-456-8980
Provider Business Practice Location Address Fax Number:
814-451-0443
Provider Enumeration Date:
06/21/2005

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: 363A00000X , with the licence number:  MA002855L , 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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