1851511471 NPI number — DR. LISA FAIRMAN PFINGSTLER M.D.

Table of content: DR. LISA FAIRMAN PFINGSTLER M.D. (NPI 1851511471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851511471 NPI number — DR. LISA FAIRMAN PFINGSTLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PFINGSTLER
Provider First Name:
LISA
Provider Middle Name:
FAIRMAN
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:
FAIRMAN
Provider Other First Name:
LISA
Provider Other Middle Name:
MARIANNE
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:
1851511471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 BEAVER DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DUBOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-371-7546
Provider Business Mailing Address Fax Number:
814-371-1906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 BEAVER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DUBOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-371-7546
Provider Business Practice Location Address Fax Number:
814-371-1906
Provider Enumeration Date:
04/26/2007

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: MA052897 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1076165 . This is a "NCCPA CERTIFICATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com