1760472484 NPI number — DR. RICHARD SEIFERT MD

Table of content: DR. RICHARD SEIFERT MD (NPI 1760472484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760472484 NPI number — DR. RICHARD SEIFERT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIFERT
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760472484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 W COHAWKIN RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08020-1145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-423-7700
Provider Business Mailing Address Fax Number:
856-423-8023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1999 SPROUL RD
Provider Second Line Business Practice Location Address:
STE 12
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-586-5018
Provider Business Practice Location Address Fax Number:
484-494-0119
Provider Enumeration Date:
10/25/2005

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: 207RC0000X , with the licence number:  MD040262 , 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: 060046620 . This is a "PALMETTO RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0719456000 . This is a "BLUE SHIELD PC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20960 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RS0000532369 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010863400006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48974 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0719456000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2295963 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232891927 . This is a "ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232891927 . This is a "BRAVO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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