1801945191 NPI number — DR. JUDITH ELAINE MCCANN DMD

Table of content: DR. JUDITH ELAINE MCCANN DMD (NPI 1801945191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801945191 NPI number — DR. JUDITH ELAINE MCCANN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCANN
Provider First Name:
JUDITH
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1801945191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 BARKSDALE RD
Provider Second Line Business Mailing Address:
101 BARKSDALE PROFESSIONAL CENTER
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19711-4535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-368-7463
Provider Business Mailing Address Fax Number:
302-368-2520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 BARKSDALE RD
Provider Second Line Business Practice Location Address:
101 BARKSDALE PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19711-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-368-7463
Provider Business Practice Location Address Fax Number:
302-368-2520
Provider Enumeration Date:
01/09/2007

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: 122300000X , with the licence number:  GI0000933 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000015397 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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