1477658599 NPI number — UNIVERSITY OF PENN-MEDICAL GROUP

Table of content: MRS. DONNA MAIRE SHAGER RN (NPI 1932253432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477658599 NPI number — UNIVERSITY OF PENN-MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF PENN-MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477658599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 SPRUCE ST
Provider Second Line Business Mailing Address:
4 PENN TOWER
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-4206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-662-2468
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 SPRUCE ST
Provider Second Line Business Practice Location Address:
4 PENN TOWER
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-2468
Provider Business Practice Location Address Fax Number:
215-349-8529
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
CHANTE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ENROLLMENT LEAD
Authorized Official Telephone Number:
215-662-6187

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , 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: 496680 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0238576000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30009058 . This is a "MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5507103 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA0235 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0002Y20116 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 273544 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33631 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006610360 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 482524 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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