1770840290 NPI number — DR. JUSTIN GERARD TUNIS MD

Table of content: DR. JUSTIN GERARD TUNIS MD (NPI 1770840290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770840290 NPI number — DR. JUSTIN GERARD TUNIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUNIS
Provider First Name:
JUSTIN
Provider Middle Name:
GERARD
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:
1770840290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N ACADEMY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-6144
Provider Business Mailing Address Fax Number:
570-271-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 MULBERRY STREET
Provider Second Line Business Practice Location Address:
GEISINGER COMMUNITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18510-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-808-7300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2012

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: 207QS0010X , with the licence number:  MD455021 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD455021 , 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)