Basic Information
| Provider Information | |||||||||
| NPI: | 1902015126 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH ACCESS NETWORK | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | HAN DREXEL HILL MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2602 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190132040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104977407 | ||||||||
| FaxNumber: | 6104977487 | ||||||||
| Practice Location | |||||||||
| Address1: | 5030 STATE RD | ||||||||
| Address2: | SUITE 2400 | ||||||||
| City: | DREXEL HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190264605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103941350 | ||||||||
| FaxNumber: | 6103941356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PRECHTL | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6103388386 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 55735000 | 01 | PA | AETNA EPDB GROUP | OTHER | 0878945002 | 01 | PA | IBC MHS GROUP | OTHER | 846065 | 01 | PA | PABS GROUP AA | OTHER |