1487875340 NPI number — GREGORY D KERSH D C P C

Table of content: (NPI 1487875340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487875340 NPI number — GREGORY D KERSH D C P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY D KERSH D C P C
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:
NEW TOWN CHIROPRACTIC & PHYSICAL THERAPY
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:
1487875340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9351 LAKESIDE BLVD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-998-3111
Provider Business Mailing Address Fax Number:
410-998-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9351 LAKESIDE BLVD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-998-3111
Provider Business Practice Location Address Fax Number:
410-998-3113
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KERSH
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT, OWNER
Authorized Official Telephone Number:
410-998-3111

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  S01706 , 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: 187207 . This is a "MEDICARE PTAN -DBA - NEW TOWN CHIRO..." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 297921 . This is a "MAMSI, MDIPA, OPT CH. ID" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".
  • Identifier: 187205YBVU . This is a "MEDICARE PTAN INDIVIDUAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4595917 . This is a "AETNA ID NUMBER" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".
  • Identifier: E301 . This is a "BLUE CHOICE,FEDERAL BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: M453 . This is a "CAREFIRST BCBS ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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