Healthcare Provider Details

I. General information

NPI: 1336215227
Provider Name (Legal Business Name): ST LUKE'S SACRED HEART CAMPUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CHEW ST
ALLENTOWN PA
18102
US

IV. Provider business mailing address

421 CHEW ST
ALLENTOWN PA
18102-3490
US

V. Phone/Fax

Practice location:
  • Phone: 610-776-5315
  • Fax: 610-663-3107
Mailing address:
  • Phone: 610-776-5315
  • Fax: 610-663-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number195501
License Number StatePA

VIII. Authorized Official

Name: MR. SUSAN A CHIAVAROLI
Title or Position: SUPERVISOR ENROLLMENTS
Credential:
Phone: 484-526-3569