1730433186 NPI number — CHESTER COUNTY INFECTIOUS DISEASES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730433186 NPI number — CHESTER COUNTY INFECTIOUS DISEASES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTER COUNTY INFECTIOUS DISEASES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1730433186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-0110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-594-7590
Provider Business Mailing Address Fax Number:
610-594-7597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 MAPLE AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-430-8200
Provider Business Practice Location Address Fax Number:
610-350-3099
Provider Enumeration Date:
11/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GOLSHAN
Authorized Official First Name:
NASRIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
610-430-8200

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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