1518247378 NPI number — CHESTER RIVER HEALTH LAB

Table of content: (NPI 1518247378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518247378 NPI number — CHESTER RIVER HEALTH LAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTER RIVER HEALTH LAB
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:
1518247378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119C N MAIN ST
Provider Second Line Business Mailing Address:
DOGWOOD PLAZA
Provider Business Mailing Address City Name:
GALENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21635-1555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-648-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119C N MAIN ST
Provider Second Line Business Practice Location Address:
DOGWOOD PLAZA
Provider Business Practice Location Address City Name:
GALENA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21635-1555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-648-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FORRESTER
Authorized Official First Name:
CARDELLA
Authorized Official Middle Name:
TRYTHALL
Authorized Official Title or Position:
DIRECTOR, PATIENT FINANCIAL SERVICE
Authorized Official Telephone Number:
410-810-5192

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  21D022037 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000265800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com