1649831751 NPI number — DELREY MARIE MCARDLE PT

Table of content: SUSAN CARRASCO (NPI 1548804925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649831751 NPI number — DELREY MARIE MCARDLE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCARDLE
Provider First Name:
DELREY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCARDLE
Provider Other First Name:
DELREY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649831751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 COAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NESQUEHONING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18240-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 W RAILROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NESQUEHONING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18240-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-669-6580
Provider Business Practice Location Address Fax Number:
570-669-9266
Provider Enumeration Date:
06/28/2019

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: 225100000X , with the licence number:  PT005165L , 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)