1003840489 NPI number — MS. CARLA JANITA CARMICHAEL CTRS

Table of content: MS. CARLA JANITA CARMICHAEL CTRS (NPI 1003840489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003840489 NPI number — MS. CARLA JANITA CARMICHAEL CTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARMICHAEL
Provider First Name:
CARLA
Provider Middle Name:
JANITA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CTRS
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:
1003840489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3305 PEDDICOAT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21163-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-922-0587
Provider Business Mailing Address Fax Number:
410-605-7686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 LOCH RAVEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-605-7550
Provider Business Practice Location Address Fax Number:
410-605-7686
Provider Enumeration Date:
07/10/2006

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: 225800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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