1659335453 NPI number — DAVID R RENNER PAC

Table of content: (NPI 1255940458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659335453 NPI number — DAVID R RENNER PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENNER
Provider First Name:
DAVID
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
M

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:
1659335453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
623 E BROAD ST
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18018-6332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-954-6048
Provider Business Mailing Address Fax Number:
610-954-3189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OSTRUM ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
FOUNTAIN HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-807-9400
Provider Business Practice Location Address Fax Number:
610-997-6326
Provider Enumeration Date:
04/17/2006

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: 363A00000X , with the licence number:  MA001272L , 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)





Copyright © 2007-2025 www.npivalidator.com