1982868451 NPI number — MRS. LORI ANN PAZZABON PT

Table of content: MRS. LORI ANN PAZZABON PT (NPI 1982868451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982868451 NPI number — MRS. LORI ANN PAZZABON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAZZABON
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAUMANN
Provider Other First Name:
LORI
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982868451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 107 PROFESSIONAL PLAZA
Provider Business Mailing Address City Name:
N CHARLEROI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-483-1673
Provider Business Mailing Address Fax Number:
724-429-0290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 BROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012-1664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-929-5774
Provider Business Practice Location Address Fax Number:
724-929-9524
Provider Enumeration Date:
07/15/2008

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: 225100000X , with the licence number:  PT019330 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT019330 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 396610 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001593585 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 396751 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001674997 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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