1700263936 NPI number — MRS. CARLY PELCHEN EDWARDS MS, RD, LDN

Table of content: MRS. CARLY PELCHEN EDWARDS MS, RD, LDN (NPI 1700263936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700263936 NPI number — MRS. CARLY PELCHEN EDWARDS MS, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
CARLY
Provider Middle Name:
PELCHEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, 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:
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:
1700263936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 N DITHRIDGE ST APT 401
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:
15213-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-875-0835
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY DRIVE C
Provider Second Line Business Practice Location Address:
MAIL STOP: 120 NF-U
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-360-3766
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2015

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:  DN00502 , 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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