1538678198 NPI number — MARY ELISABETH ROBINSON RD, LDN

Table of content: MARY ELISABETH ROBINSON RD, LDN (NPI 1538678198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538678198 NPI number — MARY ELISABETH ROBINSON RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
MARY
Provider Middle Name:
ELISABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ECKER
Provider Other First Name:
MARY
Provider Other Middle Name:
ELISABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538678198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 W TEMPLE AVE APT B4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELLERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18960-2381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-613-8897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 CHURCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH WALES
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-613-8246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2017

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: 133V00000X , with the licence number:  DN006018 , 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)





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