1902076540 NPI number — CATHERINE SELTH SPAYD PH.D.

Table of content: JORDAN MARY CHERETIS (NPI 1912553843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902076540 NPI number — CATHERINE SELTH SPAYD PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAYD
Provider First Name:
CATHERINE
Provider Middle Name:
SELTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1902076540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
841 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNCANSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16635-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-693-0617
Provider Business Mailing Address Fax Number:
814-317-0348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCANSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16635-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-693-0617
Provider Business Practice Location Address Fax Number:
814-317-0348
Provider Enumeration Date:
03/11/2008

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: 103TC0700X , with the licence number:  PS006177L , 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: 01704924 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 211350 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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