1962620062 NPI number — DRS. DIMARZIO,GORDON,JACKSON,KINZER,MILLER&VERKOUW, PA

Table of content: (NPI 1962620062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962620062 NPI number — DRS. DIMARZIO,GORDON,JACKSON,KINZER,MILLER&VERKOUW, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. DIMARZIO,GORDON,JACKSON,KINZER,MILLER&VERKOUW, PA
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:
GREATER ANNAPOLIS MEDICAL GROUP
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:
1962620062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2003 MEDICAL PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-573-1110
Provider Business Mailing Address Fax Number:
410-266-0714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-7992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-573-1110
Provider Business Practice Location Address Fax Number:
410-266-0714
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
INZER
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
410-573-1110

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SRRGA . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4421835 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S103 . This is a "BCBS DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 652102900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KS82GR . This is a "BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KS82GR . This is a "BCBS POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com