1801883061 NPI number — RICHARD D ALLATT MD

Table of content: RICHARD D ALLATT MD (NPI 1801883061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801883061 NPI number — RICHARD D ALLATT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLATT
Provider First Name:
RICHARD
Provider Middle Name:
D
Provider Name Prefix Text:
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:
1801883061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOALSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16827-0251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-235-3051
Provider Business Mailing Address Fax Number:
814-359-5629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 W COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT GAP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16823-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-359-5620
Provider Business Practice Location Address Fax Number:
814-359-5629
Provider Enumeration Date:
10/03/2005

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: 208100000X , with the licence number:  MD049145-L , 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: 250006141 . This is a "RAILROAD MEDICARE#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01016501 . This is a "CAPITAL BCBS#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014022620001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 486108 . This is a "HIGHMARK BCBS#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 097686 . This is a "MEDICARE LEGACY GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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