1831260413 NPI number — MS. ANNE MARIE DUDLEY MED

Table of content: MS. ANNE MARIE DUDLEY MED (NPI 1831260413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831260413 NPI number — MS. ANNE MARIE DUDLEY MED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUDLEY
Provider First Name:
ANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEE PELIKAN
Provider Other First Name:
ANNE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831260413
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:
PO BOX 185
Provider Second Line Business Mailing Address:
47 PEARL ST
Provider Business Mailing Address City Name:
ARENDTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-677-9729
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARENDTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-677-9729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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