1790862977 NPI number — DR. ROBERT LEO WELLNER DO

Table of content: DR. ROBERT LEO WELLNER DO (NPI 1790862977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790862977 NPI number — DR. ROBERT LEO WELLNER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLNER
Provider First Name:
ROBERT
Provider Middle Name:
LEO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1790862977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1461 COLESVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18015-5221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-442-7807
Provider Business Mailing Address Fax Number:
609-895-1032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1461 COLESVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-5221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-442-7807
Provider Business Practice Location Address Fax Number:
609-895-1032
Provider Enumeration Date:
11/01/2006

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: 207LP2900X , with the licence number:  25MB07771400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: OS011916 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 20A8689 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: OS011916 , 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: 0094463 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22-1994560 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50065555 . This is a "KEYSTONE HEALTH PLAN CENTRAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50078774 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7441837 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2797879000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4729920 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00448881 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00661480 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2261859 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2797879000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50065555 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50078774 . This is a "KEYSTONE HEALTH PLAN CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 107840 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1537403 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "FIRST MCO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "PROCURA MANAGEMENT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 113861400 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1928843 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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