1841298122 NPI number — DR. PATRICIA H PURCELL M.D.

Table of content: DR. PATRICIA H PURCELL M.D. (NPI 1841298122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841298122 NPI number — DR. PATRICIA H PURCELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURCELL
Provider First Name:
PATRICIA
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1841298122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 CHELTENHAM RD
Provider Second Line Business Mailing Address:
WEST MINISTER
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-1504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-683-9192
Provider Business Mailing Address Fax Number:
302-655-4265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1508 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19806-4338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-428-1142
Provider Business Practice Location Address Fax Number:
302-655-4265
Provider Enumeration Date:
07/12/2005

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: 208000000X , with the licence number:  C10001638 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000177702 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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