1770877904 NPI number — REBECCA AHRENS-NICKLAS MD, PHD

Table of content: REBECCA AHRENS-NICKLAS MD, PHD (NPI 1770877904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770877904 NPI number — REBECCA AHRENS-NICKLAS MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHRENS-NICKLAS
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
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:
1770877904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34TH & CIVIC CENTER BOULEVARD, 9NW55
Provider Second Line Business Mailing Address:
CHOP-PEDIATRICS/MEDICAL GENETICS RESIDENCY PROGRAM
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-4399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-590-1220
Provider Business Mailing Address Fax Number:
215-590-2768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34TH & CIVIC CENTER BOULEVARD, 9NW55
Provider Second Line Business Practice Location Address:
CHOP-PEDIATRICS/MEDICAL GENETICS RESIDENCY PROGRAM
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-1220
Provider Business Practice Location Address Fax Number:
215-590-2768
Provider Enumeration Date:
06/06/2011

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: 207SG0201X , with the licence number:  MT200141 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MT200141 , 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)





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