Provider Demographics
NPI:1720198443
Name:INFECTIOUS DISEASE ASSOCIATES OF THE LEHIGH VALLEY PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES OF THE LEHIGH VALLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-438-2427
Mailing Address - Street 1:PO BOX 20907
Mailing Address - Street 2:
Mailing Address - City:LEHIGH VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18002-0907
Mailing Address - Country:US
Mailing Address - Phone:610-438-2427
Mailing Address - Fax:610-923-9661
Practice Address - Street 1:3735 EASTON NAZARETH HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8338
Practice Address - Country:US
Practice Address - Phone:610-923-9663
Practice Address - Fax:610-923-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00101203860Medicaid
PA083176Medicare ID - Type Unspecified