1942368196 NPI number — J FREDERICK LAUCIUS MD LEWIS J ROSE MD ANDREW E CHAPMAN DO ET AL

Table of content: (NPI 1942368196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942368196 NPI number — J FREDERICK LAUCIUS MD LEWIS J ROSE MD ANDREW E CHAPMAN DO ET AL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J FREDERICK LAUCIUS MD LEWIS J ROSE MD ANDREW E CHAPMAN DO ET AL
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:
1942368196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-238-1139
Provider Business Mailing Address Fax Number:
215-574-1492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 1321
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-238-1139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DALESSIO
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
215-238-1139

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000026192 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0061424000 . This is a "KEYSTONE PC" identifier . This identifiers is of the category "OTHER".




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