1821180704 NPI number — DR. HAZEL S GUINTO MD

Table of content: DR. HAZEL S GUINTO MD (NPI 1821180704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821180704 NPI number — DR. HAZEL S GUINTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUINTO
Provider First Name:
HAZEL
Provider Middle Name:
S
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:
1821180704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 S BRYN MAWR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYN MAWR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19010-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-337-4618
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 S BRYN MAWR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-337-4618
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006

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: 207PP0204X , with the licence number:  C10006817 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: C10006817 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X , with the licence number: C10006817 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD062418-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: 1661943 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7614223 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q06817 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9100903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135249 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2740361 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4014634 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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