1144304965 NPI number — MARIA CECILIA ALBORES-HARRIS PT

Table of content: MARIA CECILIA ALBORES-HARRIS PT (NPI 1144304965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144304965 NPI number — MARIA CECILIA ALBORES-HARRIS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBORES-HARRIS
Provider First Name:
MARIA CECILIA
Provider Middle Name:
Provider Name Prefix Text:
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:
ANDERSON
Provider Other First Name:
MARIA CECILIA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144304965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-370-8206
Provider Business Mailing Address Fax Number:
517-435-3670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 RITCHIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-261-2243
Provider Business Practice Location Address Fax Number:
410-384-1617
Provider Enumeration Date:
10/25/2006

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:  18195 , 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: 149202100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: J3600004 . This is a "BCBS FEP PROVIDER NO." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 63978901 . This is a "BCBS COMMERCIAL PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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