1427057025 NPI number — ROBERT MICHELSON M.D.

Table of content: ROBERT MICHELSON M.D. (NPI 1427057025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427057025 NPI number — ROBERT MICHELSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHELSON
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1427057025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820933
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-0933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-663-9095
Provider Business Mailing Address Fax Number:
215-663-9578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 SHADY LN
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
HUNTINGDON VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19006-8749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-663-9095
Provider Business Practice Location Address Fax Number:
215-663-9578
Provider Enumeration Date:
07/18/2005

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: 207RP1001X , with the licence number:  MD-026331E , 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: 0061655000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1197025033 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 220025651 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007243 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2122744 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8250103 . This is a "MEDICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01086725-02 . This is a "HMA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 176270 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: B40723 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00721337 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3Y3737 . This is a "HEALTH NET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MOS134 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001086725-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 597586 . This is a "MEDICARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 168385 . This is a "OAKTREE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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