1316923345 NPI number — THOMAS D. GIOVINAZZO PA

Table of content: (NPI 1588728299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316923345 NPI number — THOMAS D. GIOVINAZZO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIOVINAZZO
Provider First Name:
THOMAS
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

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:
1316923345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 W STREET RD
Provider Second Line Business Mailing Address:
STE. 302
Provider Business Mailing Address City Name:
WARMINSTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18974-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-293-9560
Provider Business Mailing Address Fax Number:
215-293-9560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
824 MAIN ST
Provider Second Line Business Practice Location Address:
STE. 302
Provider Business Practice Location Address City Name:
PHOENIXVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19460-4478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-983-1561
Provider Business Practice Location Address Fax Number:
610-983-1569
Provider Enumeration Date:
12/21/2005

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: 363AS0400X , with the licence number:  MA050659 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: MA050659 , 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)





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