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NPI Code Detail

MEDICARE: NORTHEAST PENNSYLVANIA NEPHROLOGY ASSOCIATES PC

MEDICARE: NORTHEAST PENNSYLVANIA NEPHROLOGY ASSOCIATES PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1851436OTHERPABLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1386617967
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST PENNSYLVANIA NEPHROLOGY ASSOCIATES PC
Provider Business Mailing Address
First Line : 802 JEFFERSON AVE
Second Line :
City : SCRANTON
State : PA
Zip : 18510-1038
Country : US
Telephone Number : 570-348-0360
Fax Number : 570-348-0362
Provider Business Practice Location Address
First Line : 802 JEFFERSON AVE
Second Line :
City : SCRANTON
State : PA
Zip : 18510-1038
Country : US
Telephone Number : 570-348-0360
Fax Number : 570-348-0362
Authorized Official
Title or Position : PRESIDENT TREASURER
Name : JEREMIAH W EAGEN
Credential : MD
Telephone Number : 570-348-0360
Provider Enumeration Date : 02/13/2006
Last Update Date : 11/05/2009

Similar Medicare Providers

1053315085 — DR. JOHN E PRIOR D.O.
Practice Location Address:
802 JEFFERSON AVE
SCRANTON, PA
18510-1038
Practice Phone: 570-348-0360
Practice Fax: 570-348-0362
1487659744 — DR. JEREMIAH W EAGEN MD
Practice Location Address:
802 JEFFERSON AVE
SCRANTON, PA
18510-1038
Practice Phone: 570-348-0360
Practice Fax: 570-348-0362
1295733194 — ROGER T GETTS DO
Practice Location Address:
802 JEFFERSON AVE
SCRANTON, PA
18510-1038
Practice Phone: 570-348-0360
Practice Fax: 574-348-0362
1578542999 — KENNETH H RUDOLPH MD
Practice Location Address:
802 JEFFERSON AVE
SCRANTON, PA
18510-1038
Practice Phone: 570-343-3999
Practice Fax: 570-343-2749
1437118411 — MR. MICHAEL J BACCOLI MD
Practice Location Address:
802 JEFFERSON AVE
SCRANTON, PA
18510-1038
Practice Phone: 570-348-1118
Practice Fax: 570-348-1118
1023055852 — SCRANTON NEUROLOGICAL ASSOCIATES PC
Practice Location Address:
802 JEFFERSON AVENUE , 5TH FLOOR
SCRANTON, PA
18510-1038
Practice Phone: 570-348-1118
Practice Fax: 570-348-1109

Directions to “NORTHEAST PENNSYLVANIA NEPHROLOGY ASSOCIATES PC ” Practice Location

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