1740319631 NPI number — MRS. GRACE MARIE DAWGERT MA

Table of content: MRS. GRACE MARIE DAWGERT MA (NPI 1740319631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740319631 NPI number — MRS. GRACE MARIE DAWGERT MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWGERT
Provider First Name:
GRACE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1740319631
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:
1006 WOODLAND WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKS SUMMIT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18411-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-587-5437
Provider Business Mailing Address Fax Number:
570-346-7450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 VIEWMONT DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKSON CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-587-5437
Provider Business Practice Location Address Fax Number:
570-346-7450
Provider Enumeration Date:
03/05/2007

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: 235Z00000X , 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: 075899 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5295529 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 769295 . This is a "HIMARK BLUE CROSS SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001683790001 . This is a "DEPT OF MEDICAL ASSISTANC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 769295 . This is a "CAPITOL BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1215 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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