1710921432 NPI number — MS. THERESA B DARGIS PAC

Table of content: MS. THERESA B DARGIS PAC (NPI 1710921432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710921432 NPI number — MS. THERESA B DARGIS PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARGIS
Provider First Name:
THERESA
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1710921432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 W RIDGE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMERICK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19468-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-226-6200
Provider Business Mailing Address Fax Number:
610-226-6201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 LANTANA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOCKESSIN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19707-8807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-234-4000
Provider Business Practice Location Address Fax Number:
302-466-9701
Provider Enumeration Date:
06/15/2006

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: 363A00000X , with the licence number:  C50000538 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1710924321 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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