1538265871 NPI number — AMANDA L PELPHREY

Table of content: AMANDA L PELPHREY (NPI 1538265871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538265871 NPI number — AMANDA L PELPHREY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELPHREY
Provider First Name:
AMANDA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1538265871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 THORN RUN RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAOPOLIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15108-3102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-329-7778
Provider Business Mailing Address Fax Number:
412-262-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 BEAVER GRADE RD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAOPOLIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-329-7778
Provider Business Practice Location Address Fax Number:
412-262-1555
Provider Enumeration Date:
09/15/2006

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: 103TC2200X , with the licence number:  PS016072 , 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)