1700996584 NPI number — CHRISTOPHER LENGEL

Table of content: CHRISTOPHER LENGEL (NPI 1700996584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700996584 NPI number — CHRISTOPHER LENGEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENGEL
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1700996584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 BOSTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21224-4981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-522-2177
Provider Business Mailing Address Fax Number:
410-522-2178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 BOSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-4981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-522-2177
Provider Business Practice Location Address Fax Number:
410-522-2178
Provider Enumeration Date:
08/30/2006

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: 225100000X , with the licence number:  19813 , 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: 378822 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 604787-02 . This is a "BCBS/MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7416479 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 215675 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2341840 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 68241 . This is a "PRUDENTIAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 80705 . This is a "GREAT WEST 1 HEALTH PALN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 33752 . This is a "IWIF" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 47610071 . This is a "BCBS/DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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