1750327268 NPI number — SANDERS MOBILE PODIATRY INC

Table of content: (NPI 1750327268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750327268 NPI number — SANDERS MOBILE PODIATRY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDERS MOBILE PODIATRY INC
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:
1750327268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 DECATUR 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:
21230-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-493-9439
Provider Business Mailing Address Fax Number:
443-836-0722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 DECATUR 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:
21230-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-493-9439
Provider Business Practice Location Address Fax Number:
443-836-0722
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-493-9439

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  E10000178 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01405 . This is a "MARYLAND PODIATRY LIC#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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