1952442238 NPI number — TALBOT COUNTY HEALTH DEPARTMENT ADDICTIONS PROGRAM

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 1952442238 NPI number — TALBOT COUNTY HEALTH DEPARTMENT ADDICTIONS PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALBOT COUNTY HEALTH DEPARTMENT ADDICTIONS PROGRAM
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:
1952442238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 BAY STREET
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-2796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-819-5900
Provider Business Mailing Address Fax Number:
410-819-0591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 BAY STREET
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-2796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-819-5900
Provider Business Practice Location Address Fax Number:
410-819-0591
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
410-819-5900

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  903058 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 903406 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 655252801 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 655252801 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 655252801 . This is a "MARYLAND PHYSICIANS CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: VA10 . This is a "CARE FIRST BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 655252801 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106469 . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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