1538213715 NPI number — HAGERSTOWN EAR NOSE & THROAT ASSOCIATES

Table of content: (NPI 1538213715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538213715 NPI number — HAGERSTOWN EAR NOSE & THROAT ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAGERSTOWN EAR NOSE & THROAT 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:
Provider Other Organization Name Type Code:
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:
1538213715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
363 S CLEVELAND AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21740-5747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-790-0444
Provider Business Mailing Address Fax Number:
301-739-3275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
363 S CLEVELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-790-0444
Provider Business Practice Location Address Fax Number:
301-739-3275
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BANDY
Authorized Official First Name:
BIBHAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-790-0444

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  D0015485 , 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: 221028 . This is a "MAMSI HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08357440005 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: E4250001 . This is a "FEDERAL BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 041923465A . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 910951000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: C043 . This is a "CAREFIRS BCBS" identifier . This identifiers is of the category "OTHER".




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