1104883883 NPI number — EDWARD MICHAEL EHLERS MD

Table of content: EDWARD MICHAEL EHLERS MD (NPI 1104883883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104883883 NPI number — EDWARD MICHAEL EHLERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EHLERS
Provider First Name:
EDWARD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1104883883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 SETON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-723-5030
Provider Business Mailing Address Fax Number:
301-723-6485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-723-5030
Provider Business Practice Location Address Fax Number:
301-723-6485
Provider Enumeration Date:
04/27/2006

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: 2084P0800X , with the licence number:  D0005139 , 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: 001668013002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001668013002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1045323 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52633 . This is a "HORIZON HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41311703 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 40344520 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 63821800 . This is a "MAPS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: IP14197 . This is a "MAGELLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0116350000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33721 . This is a "VALUES OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: M093 0002 . This is a "BLUE CHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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