1336130038 NPI number — DR. STANLEY SOL SCHOCKET M.D.

Table of content: DR. STANLEY SOL SCHOCKET M.D. (NPI 1336130038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336130038 NPI number — DR. STANLEY SOL SCHOCKET M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOCKET
Provider First Name:
STANLEY
Provider Middle Name:
SOL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1336130038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 CROSSROADS DR
Provider Second Line Business Mailing Address:
SUITE #425
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-581-2020
Provider Business Mailing Address Fax Number:
410-654-9264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 CROSSROADS DR
Provider Second Line Business Practice Location Address:
SUITE #425
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-581-2020
Provider Business Practice Location Address Fax Number:
410-654-9264
Provider Enumeration Date:
11/02/2005

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: 174400000X , with the licence number:  D15055 , 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: 309471500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 217871 . This is a "MD IPA PROVIDER ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C52-1828318-011 . This is a "CIGNA PROVIDER ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R7020003 . This is a "BLUE CHOICE PROVIDER ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 97730 . This is a "FLEXCHOICE PROVIDER ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52-1828318-103 . This is a "PRUDENTIAL PROVIDER ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 500858 . This is a "AETNA INS. PROVIDER ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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