Basic Information
| Provider Information | |||||||||
| NPI: | 1750336541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULMONARY ASSOCIATES P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4745 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023685515 | ||||||||
| FaxNumber: | 3023661240 | ||||||||
| Practice Location | |||||||||
| Address1: | 7TH & CLAYTON STS | ||||||||
| Address2: | MED OFC BLDG SUITE 500 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198054418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026135080 | ||||||||
| FaxNumber: | 3023277313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | RIZZO | ||||||||
| AuthorizedOfficialFirstName: | ALBERT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3023685515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 1989017157 | DE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | K907 | 01 | DE | BCBS MARYLAND | OTHER | CB9776 | 01 | RR MEDICARE | OTHER | 0085017000 | 01 | DE | AMERIHEALTH/KEYSTONE | OTHER |