NPI |
1124594320 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Entity Type Code |
1 |
The first name of the provider, if the provider
is an individual. |
Provider Last Name Legal Name |
ANDREUZZI |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
RICHARD |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
ANDREW |
The middle name of the provider, if the provider
is an individual. |
Provider Credential Text |
PA-C |
The city name in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
2 US-15 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address City Name |
ALLENWOOD |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address State Name |
PA |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
17810 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5705471990 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Enumeration Date |
10/16/2018 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
10/16/2018 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
363A00000X |
The code designating the provider’s gender if the provider is a person. |
Provider License Number 1 |
MA054178 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
PA |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Healthcare Provider Taxonomy Code 2 |
363A00000X |
|
Provider License Number 2 |
OA002460 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 2 |
PA |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |