1417004250 NPI number — CENTRAL MARYLAND PRIMARY CARE ASSOCIATES

Table of content: (NPI 1417004250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417004250 NPI number — CENTRAL MARYLAND PRIMARY CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL MARYLAND PRIMARY CARE ASSOCIATES
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:
CENTRAL MARYLAND PRIMARY CARE ASSOCIATES
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:
1417004250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 BACK RIVER NECK RD
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21221-3949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-391-8733
Provider Business Mailing Address Fax Number:
410-391-9630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 BACK RIVER NECK RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21221-3949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-391-8733
Provider Business Practice Location Address Fax Number:
410-391-9630
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SABAPATHI
Authorized Official First Name:
RAMESH
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR PARTNER
Authorized Official Telephone Number:
410-391-8733

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 368161100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 402778700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KZ87CE . This is a "BLUE CROSS GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E54900 . This is a "FEDERAL BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 35180307 . This is a "CAREFIRST BS DR SABPATHI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 934675900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: E549004 . This is a "FED BC BS DR SABAPATHI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 621313 . This is a "CAREFIRST BC DR KHETERPAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E5490010 . This is a "FED BC BS DR KHETERPAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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