1750460333 NPI number — SARAH ANN SMITH-PUTMAN LC-ADC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750460333 NPI number — SARAH ANN SMITH-PUTMAN LC-ADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-PUTMAN
Provider First Name:
SARAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LC-ADC
Provider Gender Code:
F

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:
1750460333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRUMPTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21628-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-994-9582
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-994-9582
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2006

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: 101YA0400X , with the licence number:  LCA208 , 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: 648429-01 . This is a "BLUE CROSS BLUE SHIELD MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100079084 . This is a "AMERICAN PSYCH SYSTEMS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2144062 . This is a "MAMSI/UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 206966 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T418-0014 . This is a "BCBS/GHMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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