Basic Information
Provider Information
NPI: 1639105877
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NORRIS
FirstName: ANNE
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 51 N 39TH ST
Address2: 3910 BUILDING, 2ND FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191042640
CountryCode: US
TelephoneNumber: 2156629990
FaxNumber: 2152434658
Practice Location
Address1: 51 N 39TH ST
Address2: 3910 BUILDING, 2ND FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191042640
CountryCode: US
TelephoneNumber: 2156629990
FaxNumber: 2152434658
Other Information
ProviderEnumerationDate: 06/22/2006
LastUpdateDate: 09/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XMD048997LPAY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

ID Information
IDTypeStateIssuerDescription
001571247000605PA MEDICAID


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