Provider Demographics
NPI:1043258015
Name:LEHIGH VALLEY NEPHROLOGY ASSOC
Entity type:Organization
Organization Name:LEHIGH VALLEY NEPHROLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PURSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-865-5888
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:610-865-5888
Mailing Address - Fax:610-865-1697
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 602
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:610-865-5888
Practice Address - Fax:610-865-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
20044600OtherAMERIHEALTH MERCY HEALTH
PA0011249240021Medicaid
1519711OtherGATEWAY HEALTH PLAN
131084OtherUNISON HEALTH PLAN
02348300OtherCAPITAL BLUE CROSS
193798OtherHIGHMARK BLUE SHIELD
NJ3564401Medicaid
6000OtherGEISINGER HEALTH PLAN
NJ3564401Medicaid
NJ065042Medicare PIN
131084OtherUNISON HEALTH PLAN