1356433403 NPI number — STINSON AND GRECO MD, PA

Table of content: (NPI 1356433403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356433403 NPI number — STINSON AND GRECO MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STINSON AND GRECO MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA METROPOLITAN RADIATION ONCOLOGY SPECIALISTS
Provider Other Organization Name Type Code:
3
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:
1356433403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 630514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21263-0514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-392-3011
Provider Business Mailing Address Fax Number:
585-359-3353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 ROCKLEDGE DR
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-7837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-896-2012
Provider Business Practice Location Address Fax Number:
301-897-1331
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STINSON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
301-896-2012

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3131655 . This is a "AETNA GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4342224-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90001 . This is a "NCPPO GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 220700 . This is a "MAMSI GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0344293-00 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: KAU7ME . This is a "MD CAREFIRST BC/BS GRP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S357 . This is a "DC CAREFIRST BC/BS GRP #" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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