1780203695 NPI number — DR. MARIA JEAN D'AMICO MD

Table of content: DR. MARIA JEAN D'AMICO MD (NPI 1780203695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780203695 NPI number — DR. MARIA JEAN D'AMICO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'AMICO
Provider First Name:
MARIA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1780203695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT OF UROLOGY THOMAS JEFFERSON UNIVERSITY
Provider Second Line Business Mailing Address:
1025 WALNUT STREET, SUITE 1100
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-955-1416
Provider Business Mailing Address Fax Number:
215-923-1884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 CHESTNUT ST STE 703
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-955-1000
Provider Business Practice Location Address Fax Number:
215-503-2066
Provider Enumeration Date:
04/10/2020

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: 208800000X , with the licence number:  MT220661 , 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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