1134335508 NPI number — MS. JENNIFER RENEE CARMICHAEL PT

Table of content: MS. JENNIFER RENEE CARMICHAEL PT (NPI 1134335508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134335508 NPI number — MS. JENNIFER RENEE CARMICHAEL PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARMICHAEL
Provider First Name:
JENNIFER
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BACHMAN
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134335508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5266 FRETER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELDERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21784-9311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-552-6659
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6190 GEORGETOWN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21784-6460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-552-4235
Provider Business Practice Location Address Fax Number:
410-552-4248
Provider Enumeration Date:
05/15/2007

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:  19921 , 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: 208505 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3401675 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7521190 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5578 . This is a "HELIX" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4761-0132 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609010-01 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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