1720184245 NPI number — RALPH J DEMARINO DC

Table of content: RALPH J DEMARINO DC (NPI 1720184245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720184245 NPI number — RALPH J DEMARINO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMARINO
Provider First Name:
RALPH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1720184245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 BAINBRIDGE ST
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-922-6333
Provider Business Mailing Address Fax Number:
215-922-6310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 BAINBRIDGE ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-922-6333
Provider Business Practice Location Address Fax Number:
215-922-6310
Provider Enumeration Date:
09/15/2006

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: 111N00000X , with the licence number:  DC006178L , 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)

  • Identifier: 01561895 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0167580000 . This is a "PERSONAL CHOICE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0167580000 . This is a "KEYSTONE EAST GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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