1952480345 NPI number — MRS. DOROTHY SHIPLEY P.T.

Table of content: MRS. DOROTHY SHIPLEY P.T. (NPI 1952480345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952480345 NPI number — MRS. DOROTHY SHIPLEY P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIPLEY
Provider First Name:
DOROTHY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1952480345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 TIDEWATER COLONY DRIVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-2592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-266-8010
Provider Business Mailing Address Fax Number:
443-782-2498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 TIDEWATER COLONY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-2592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-266-8010
Provider Business Practice Location Address Fax Number:
443-782-2498
Provider Enumeration Date:
11/04/2006

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: 225100000X , with the licence number:  18880 , 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: 2777855 . This is a "CAREFIRST BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 277855 . This is a "MAMSI HEALTH CARE" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".
  • Identifier: S441003 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7691439 . This is a "AETNA HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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