1538144050 NPI number — DR. EVA JEANEAL DUCKETT M.D.

Table of content: DR. EVA JEANEAL DUCKETT M.D. (NPI 1538144050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538144050 NPI number — DR. EVA JEANEAL DUCKETT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUCKETT
Provider First Name:
EVA
Provider Middle Name:
JEANEAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHARPE
Provider Other First Name:
EVA
Provider Other Middle Name:
JEANEAL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538144050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 DEFENSE HWY
Provider Second Line Business Mailing Address:
CHESAPEAKE MEDICAL IMAGING
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-571-0350
Provider Business Mailing Address Fax Number:
410-571-0350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 DEFENSE HWY
Provider Second Line Business Practice Location Address:
CHESAPEAKE MEDICAL IMAGING
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-7069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-571-0350
Provider Business Practice Location Address Fax Number:
410-571-9348
Provider Enumeration Date:
12/07/2005

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: 2085R0202X , with the licence number:  MD21048 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: D0056558 , 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: P00455075 . This is a "MEDICARE RAILROAD CARRIER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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