1477716140 NPI number — ABIGAIL MARJORIE OSTERTAG PA-C

Table of content: ABIGAIL MARJORIE OSTERTAG PA-C (NPI 1477716140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477716140 NPI number — ABIGAIL MARJORIE OSTERTAG PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSTERTAG
Provider First Name:
ABIGAIL
Provider Middle Name:
MARJORIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
WILSON
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
MARJORIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477716140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
896 A PLAZA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-715-4425
Provider Business Mailing Address Fax Number:
717-295-4518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 PAPERMILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-220-0051
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2008

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:  005631 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: MA053452 , 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)