1831736024 NPI number — CHRISTOPHER A PANEK DPM PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831736024 NPI number — CHRISTOPHER A PANEK DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER A PANEK DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1831736024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 CRESCENT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLWOOD CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16117-1945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-758-4900
Provider Business Mailing Address Fax Number:
724-758-8190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 PERRY HWY STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-5367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-758-4900
Provider Business Practice Location Address Fax Number:
724-758-8190
Provider Enumeration Date:
12/06/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YARGO
Authorized Official First Name:
BLANCHE
Authorized Official Middle Name:
LOIS
Authorized Official Title or Position:
MANAGING EMPLOYEE
Authorized Official Telephone Number:
724-758-4900

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 434455 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".