1386924991 NPI number — ELEANOR DORIS MERBOTH CRNP

Table of content: ELEANOR DORIS MERBOTH CRNP (NPI 1386924991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386924991 NPI number — ELEANOR DORIS MERBOTH CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERBOTH
Provider First Name:
ELEANOR
Provider Middle Name:
DORIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COCHRAN
Provider Other First Name:
ELEANOR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386924991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 DOBBIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-492-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 DOBBIN RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-492-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2011

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: 363LP0200X , with the licence number:  R173589 , 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: 051086600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".