1114920576 NPI number — DR. GREGG C DONALDSON MD

Table of content: DR. GREGG C DONALDSON MD (NPI 1114920576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114920576 NPI number — DR. GREGG C DONALDSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONALDSON
Provider First Name:
GREGG
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1114920576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 SETON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-1818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-722-3111
Provider Business Mailing Address Fax Number:
301-722-5135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 SETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-722-3111
Provider Business Practice Location Address Fax Number:
301-722-5135
Provider Enumeration Date:
05/31/2005

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: 207R00000X , with the licence number:  D0042054 , 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: 766241601 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 893415 . This is a "MDIPA/OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W3990008 . This is a "BCBS FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0011509001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000220000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2100999 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 990015534 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2117570 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 528302-02 . This is a "BCBS POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P14964 . This is a "BCBS POS PRIMARY" identifier . This identifiers is of the category "OTHER".




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