1821290123 NPI number — CHARLES J CAREY PA

Table of content: CHARLES J CAREY PA (NPI 1821290123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821290123 NPI number — CHARLES J CAREY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAREY
Provider First Name:
CHARLES
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1821290123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 829641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-9641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-370-5296
Provider Business Mailing Address Fax Number:
215-230-3725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4897 YORK ROAD
Provider Second Line Business Practice Location Address:
278
Provider Business Practice Location Address City Name:
BUCKINGHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-794-7471
Provider Business Practice Location Address Fax Number:
215-794-2576
Provider Enumeration Date:
05/31/2007

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: 363A00000X , with the licence number:  25MP00023100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: MA064346 , 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)





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