1821005059 NPI number — PAUL A TARANTINO, M.D.,P.A.

Table of content: (NPI 1821005059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821005059 NPI number — PAUL A TARANTINO, M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL A TARANTINO, M.D.,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:
TARANTINO EYE 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:
1821005059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 LANDMARK DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061-4980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-590-9260
Provider Business Mailing Address Fax Number:
410-590-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1403 MADISON PARK DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-590-9260
Provider Business Practice Location Address Fax Number:
410-590-9266
Provider Enumeration Date:
08/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TARANTINO
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
ANGELO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-590-9260

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D43467 , 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)