1770512386 NPI number — MS. DENISE ROY CNM

Table of content: MS. DENISE ROY CNM (NPI 1770512386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770512386 NPI number — MS. DENISE ROY CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
DENISE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1770512386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1037 REDTAIL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUDUBON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19403-1844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-630-3273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
918 COUNTY LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-525-6086
Provider Business Practice Location Address Fax Number:
610-525-1846
Provider Enumeration Date:
07/03/2006

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: 176B00000X , with the licence number:  MW008178L , 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: 4615720 . This is a "USHC PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9171253 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 89824 . This is a "BLUE SHIELD PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1835550 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290891 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01835550-03 . This is a "AMERICHOICE-MA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 89824 . This is a "BLUE CROSS PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 89824 . This is a "KEYSTONE PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P003418 . This is a "CHAMPUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 31021 . This is a "AETNA PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 89824 . This is a "PERSONAL CHOICE PROF" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 62127000 . This is a "BLUE CROSS HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: X34384 . This is a "AMERIHEALTH ADMIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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