1720137698 NPI number — MR. RAYMOND ANDY SPEELMAN CP BOCP COF

Table of content: MR. RAYMOND ANDY SPEELMAN CP BOCP COF (NPI 1720137698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720137698 NPI number — MR. RAYMOND ANDY SPEELMAN CP BOCP COF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEELMAN
Provider First Name:
RAYMOND
Provider Middle Name:
ANDY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CP BOCP COF
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:
1720137698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
638 ROSTRAVER RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BELLE VERNON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012-1967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-350-0458
Provider Business Mailing Address Fax Number:
724-930-8545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
638 ROSTRAVER RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-350-0458
Provider Business Practice Location Address Fax Number:
724-930-8545
Provider Enumeration Date:
01/09/2007

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: 224P00000X , with the licence number:  ABC CP003203 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 224P00000X , with the licence number: BOC C16482 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2025 www.npivalidator.com