1972765063 NPI number — BARBARA PLUCKNETT MD

Table of content: KELSEY MARIE BRUA CNP (NPI 1437831724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972765063 NPI number — BARBARA PLUCKNETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA PLUCKNETT MD
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:
1972765063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 W OLIVE ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18508-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-961-9947
Provider Business Mailing Address Fax Number:
570-341-5043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
743 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18510-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-9997
Provider Business Practice Location Address Fax Number:
570-344-3158
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PLUCKNETT
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
570-344-9997

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD059852L , 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: 0016282140002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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