1154351021 NPI number — ASSOCIATES IN RADIATION MEDICINE, PC

Table of content: (NPI 1154351021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154351021 NPI number — ASSOCIATES IN RADIATION MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN RADIATION MEDICINE, PC
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:
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:
1154351021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 418837
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-8837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-846-5527
Provider Business Mailing Address Fax Number:
607-324-2369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4901 TESLA DR STE A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-805-6860
Provider Business Practice Location Address Fax Number:
301-805-0755
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SNYDER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
888-846-5527

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  D04119897 , 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: 435699 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2902 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 034401700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90200400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KA31AS 603327 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100683 . This is a "KAISER PERMANENTE GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2213967 . This is a "AETNA GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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