1518943521 NPI number — PLUM PEDIATRICS PC

Table of content: (NPI 1518943521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518943521 NPI number — PLUM PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLUM PEDIATRICS PC
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:
1518943521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
781 PINE VALLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15239-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-327-7586
Provider Business Mailing Address Fax Number:
724-327-9562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 PINE VALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15239-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-327-7586
Provider Business Practice Location Address Fax Number:
724-327-9562
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CALABRESE
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-327-7586

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD051024L , 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: 0014969000 . This is a "INDEPENDENCE BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018313820001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128877 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 917554 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5267460 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62106 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1027145 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 556984 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com