1467494096 NPI number — DR. KARIN FLYNN-RODDEN MD

Table of content: DR. KARIN FLYNN-RODDEN MD (NPI 1467494096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467494096 NPI number — DR. KARIN FLYNN-RODDEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLYNN-RODDEN
Provider First Name:
KARIN
Provider Middle Name:
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:
1467494096
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:
1629 S BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-467-7360
Provider Business Mailing Address Fax Number:
215-467-7318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 S BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-467-7318
Provider Business Practice Location Address Fax Number:
215-467-7318
Provider Enumeration Date:
06/11/2006

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: 207RA0201X , with the licence number:  25MA05399500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0201X , with the licence number: MD037839E , 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: 18348 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2303818000 . This is a "HMO KEYS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0423341000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 047950 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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