Basic Information
Provider Information | |||||||||
NPI: | 1215128541 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MUDE MISHKIN | ||||||||
FirstName: | HANNAH | ||||||||
MiddleName: | MAINA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MUDE-NOCHUMSON | ||||||||
OtherFirstName: | HANNAH | ||||||||
OtherMiddleName: | MAINA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 13579 | ||||||||
Address2: |   | ||||||||
City: | READING | ||||||||
State: | PA | ||||||||
PostalCode: | 196123579 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4846280799 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 420 S 5TH AVE | ||||||||
Address2: |   | ||||||||
City: | WEST READING | ||||||||
State: | PA | ||||||||
PostalCode: | 196112143 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4846283637 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2007 | ||||||||
LastUpdateDate: | 04/13/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MT18632 | PA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | MD434009 | PA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.