1144472283 NPI number — MARY ELLEN PADUSI

Table of content: (NPI 1144472283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144472283 NPI number — MARY ELLEN PADUSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY ELLEN PADUSI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
M. EYES
Provider Other Organization Name Type Code:
3
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:
1144472283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4134 E JOPPA RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-2284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-256-1006
Provider Business Mailing Address Fax Number:
410-256-0088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4134 E JOPPA RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-2284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-256-1006
Provider Business Practice Location Address Fax Number:
410-256-0088
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PADUSI
Authorized Official First Name:
MARY ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
410-256-1006

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA0922 , 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: 940691 . This is a "EYEMED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 613064-03 . This is a "CAREFIRST/BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 210360-121 . This is a "NVA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 50070 . This is a "DAVIS VISION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 613064-02 . This is a "CAREFIRST/BLUE CROSS&BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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