1811059306 NPI number — PENINSULA EYE CENTER, P.A

Table of content: DR. CARL RAMSES YACOUB M.D. (NPI 1386651099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811059306 NPI number — PENINSULA EYE CENTER, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENINSULA EYE CENTER, P.A
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:
PENINSULA CATARACT & LASER CENTER
Provider Other Organization Name Type Code:
3
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:
1811059306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MILFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-6952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-9290
Provider Business Mailing Address Fax Number:
410-543-9087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MILFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-6952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-9290
Provider Business Practice Location Address Fax Number:
410-543-9087
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOCK
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
410-749-9290

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1060 , 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: 213769 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57466701 . This is a "CAREFIRST BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6800028 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2353563 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45227 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5575535 . This is a "AETNA NON-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 778441400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: PH5 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0000464928 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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