1831214527 NPI number — MADELEINE QUAIL EWING MD

Table of content: MADELEINE QUAIL EWING MD (NPI 1831214527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831214527 NPI number — MADELEINE QUAIL EWING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EWING
Provider First Name:
MADELEINE
Provider Middle Name:
QUAIL
Provider Name Prefix Text:
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:
1831214527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 SPRUCE STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19106-4023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-829-6802
Provider Business Mailing Address Fax Number:
215-829-6807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 SPRUCE STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-6802
Provider Business Practice Location Address Fax Number:
215-829-6807
Provider Enumeration Date:
03/20/2007

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: 207W00000X , with the licence number:  PAMD015546E , 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: 31334 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0650275 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 835701 . This is a "HEALTH PASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: EW132512 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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