1174669196 NPI number — DANA LYNN D'AMORE OTR

Table of content: DANA LYNN D'AMORE OTR (NPI 1174669196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174669196 NPI number — DANA LYNN D'AMORE OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'AMORE
Provider First Name:
DANA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
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:
1174669196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1281 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06902-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-210-2840
Provider Business Mailing Address Fax Number:
203-210-2841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10753 FALLS RD PAVILLION II
Provider Second Line Business Practice Location Address:
#235
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-583-2665
Provider Business Practice Location Address Fax Number:
410-847-3838
Provider Enumeration Date:
01/29/2007

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: 225X00000X , with the licence number:  004100 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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