1710083241 NPI number — DR. MAYER GORBATY M.D.

Table of content: DR. MAYER GORBATY M.D. (NPI 1710083241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710083241 NPI number — DR. MAYER GORBATY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORBATY
Provider First Name:
MAYER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1710083241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 OLD COURT ROAD
Provider Second Line Business Mailing Address:
LIFEBRIDGE HEALTH, NORTHWEST HOSPITAL
Provider Business Mailing Address City Name:
RANDALLSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-701-4466
Provider Business Mailing Address Fax Number:
410-701-4598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 OLD COURT ROAD
Provider Second Line Business Practice Location Address:
NORTHWEST HOSPITAL
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-701-4466
Provider Business Practice Location Address Fax Number:
410-701-4598
Provider Enumeration Date:
09/15/2006

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: 207R00000X , with the licence number:  D0027938 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: D0027938 , 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: S325-0022 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 380511500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 414392-03 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 042765900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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