1386693968 NPI number — DR. ROMEO S ABELLA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386693968 NPI number — DR. ROMEO S ABELLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABELLA
Provider First Name:
ROMEO
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABELLA
Provider Other First Name:
ROMEO
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386693968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 W CAYUGA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-743-2250
Provider Business Mailing Address Fax Number:
215-743-4899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 E CAYUGA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-743-2250
Provider Business Practice Location Address Fax Number:
215-743-4899
Provider Enumeration Date:
05/09/2006

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: 207R00000X , with the licence number:  MD032542L , 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: 000627160 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J1744 . This is a "AMERI HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10842190 . This is a "ELDER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100129 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0053790001 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0956215 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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