1730157058 NPI number — ANDREA M PEZZELLA MD

Table of content: ANDREA M PEZZELLA MD (NPI 1730157058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730157058 NPI number — ANDREA M PEZZELLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEZZELLA
Provider First Name:
ANDREA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1730157058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 MIDLANDS CT
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29169-3456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-457-7000
Provider Business Mailing Address Fax Number:
803-457-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MIDLANDS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-457-7000
Provider Business Practice Location Address Fax Number:
803-457-7001
Provider Enumeration Date:
03/11/2006

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: 207V00000X , with the licence number:  29701 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 204555 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 29701 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1009200 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7099315 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA3715 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22633 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22633 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0120961 . This is a "MEDICAID WELFARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0700410 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0120961 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: A31235 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37554 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22633 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160049837 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45822 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784225 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com