1386736593 NPI number — CHRISTINE PENDLETON DPT

Table of content: CHRISTINE PENDLETON DPT (NPI 1386736593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386736593 NPI number — CHRISTINE PENDLETON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENDLETON
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1386736593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CARNEGIE PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-407-3422
Provider Business Mailing Address Fax Number:
877-407-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CARNEGIE PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08003-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-407-3422
Provider Business Practice Location Address Fax Number:
877-407-4329
Provider Enumeration Date:
09/28/2006

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: 225100000X , with the licence number:  2305204148 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 150718500 . This is a "DEPT OF LABOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 194085 . This is a "BCBS GROUP # WS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00264305 . This is a "RR MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4576361 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 194082 . This is a "BCBS GROUP # FR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 194083 . This is a "BCBS GROUP # WI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541966445 . This is a "UHC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541966445 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541966445 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 16040 . This is a "COMMUNITY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 182414 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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