1144416470 NPI number — MRS. BRENDA JANE CLINE RICH PT

Table of content: MRS. BRENDA JANE CLINE RICH PT (NPI 1144416470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144416470 NPI number — MRS. BRENDA JANE CLINE RICH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICH
Provider First Name:
BRENDA
Provider Middle Name:
JANE CLINE
Provider Name Prefix Text:
MRS.
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:
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:
1144416470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 BALTIMORE ANNAPOLIS BLVD
Provider Second Line Business Mailing Address:
SUITE #111
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146-3931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-384-9129
Provider Business Mailing Address Fax Number:
410-384-9725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
198 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-473-9000
Provider Business Practice Location Address Fax Number:
301-473-9840
Provider Enumeration Date:
09/20/2007

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: 2251X0800X , with the licence number:  21551 , 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)





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