1972564615 NPI number — DR. LORETTA K SCHMIDGALL OD PC

Table of content: DR. LORETTA K SCHMIDGALL OD PC (NPI 1972564615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972564615 NPI number — DR. LORETTA K SCHMIDGALL OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDGALL
Provider First Name:
LORETTA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD PC
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:
1972564615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3211 CARLISLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17315-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-292-3668
Provider Business Mailing Address Fax Number:
717-292-1034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3211 CARLISLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17315-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-292-3668
Provider Business Practice Location Address Fax Number:
717-292-1034
Provider Enumeration Date:
03/31/2006

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: 152W00000X , with the licence number:  OEG000268 , 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: 01528701 . This is a "CAPITAL BLUE CROSS PROV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01528701 . This is a "NCAS PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02523900 . This is a "CAPITAL BLUE CROSS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30540 . This is a "GROUP VISION ASSOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: A13345 . This is a "AMERIHEALTH ADMINISTRATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00148941 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: SC113345 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00148941 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01528701 . This is a "KEYSTONE HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18107 . This is a "HEALTH AMERICA ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2923668 . This is a "VISION SERVICE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95045 . This is a "VISION BENEFITS OF AMERIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00148941 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2421907 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3302 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01898579 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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