1811993207 NPI number — DR. BRIAN H JEWART M.D.

Table of content: DR. BRIAN H JEWART M.D. (NPI 1811993207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811993207 NPI number — DR. BRIAN H JEWART M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEWART
Provider First Name:
BRIAN
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1811993207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 644214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15264-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-653-3080
Provider Business Mailing Address Fax Number:
412-650-8963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9970 MOUNTAIN VIEW DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WEST MIFFLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15122-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-655-4764
Provider Business Practice Location Address Fax Number:
412-653-3580
Provider Enumeration Date:
06/22/2005

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: 207W00000X , with the licence number:  MD045592L , 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: 0000700341 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015779840009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1509303 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 13356 . This is a "ELDER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 31202 . This is a "ADVANTRA/HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 251100359004 . This is a "PGBA TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 251100359004 . This is a "TRICARE PGBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 517317 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200700 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 700341 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015779840001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: JE700341 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000065444 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com