1649258310 NPI number — DR. TULIO Q ESTRADA-QUINTERO MD

Table of content: DR. TULIO Q ESTRADA-QUINTERO MD (NPI 1649258310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649258310 NPI number — DR. TULIO Q ESTRADA-QUINTERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTRADA-QUINTERO
Provider First Name:
TULIO
Provider Middle Name:
Q
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:
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:
1649258310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 SOUTH MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-588-9830
Provider Business Mailing Address Fax Number:
724-588-9860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16125-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-588-9830
Provider Business Practice Location Address Fax Number:
724-588-9860
Provider Enumeration Date:
01/04/2006

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: 207RC0000X , with the licence number:  MD053235L , 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: 0015135010004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110123509 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com