Basic Information
Provider Information | |||||||||
NPI: | 1922292812 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MEDICAL ASSOCIATES OF THE LEHIGH VALLEY PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1605 N CEDAR CREST BLVD | ||||||||
Address2: | SUITE 110B | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181042351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109731410 | ||||||||
FaxNumber: | 6109731449 | ||||||||
Practice Location | |||||||||
Address1: | 401 N 17TH ST | ||||||||
Address2: | SUITE 202 | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181045034 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6104321427 | ||||||||
FaxNumber: | 6107749741 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/04/2007 | ||||||||
LastUpdateDate: | 09/26/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STOVER | ||||||||
AuthorizedOfficialFirstName: | ROBERT | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 6109731410 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 1982057 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | CA1229 | 01 | PA | PALMETTO RR | OTHER | 50071839 | 01 | PA | CAPITAL BLUE CROSS | OTHER |