1013015817 NPI number — DR. LISA A DIMARZIO MD

Table of content: DR. LISA A DIMARZIO MD (NPI 1013015817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013015817 NPI number — DR. LISA A DIMARZIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMARZIO
Provider First Name:
LISA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013015817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2003 MEDICAL PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-573-1110
Provider Business Mailing Address Fax Number:
410-266-0714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 MEDICAL PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-573-1110
Provider Business Practice Location Address Fax Number:
410-266-0714
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  038158 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 093371600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260077 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0401156 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110060518 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P0409 . This is a "PRINCIPLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260077 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4269169 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P11673 . This is a "BCBS POINT OF SERVICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1496254 . This is a "UNITED MINE WORKERS ASSOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52129501 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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