1174839062 NPI number — MISS AYANA KARA TORRENCE M.P.T

Table of content: MISS AYANA KARA TORRENCE M.P.T (NPI 1174839062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174839062 NPI number — MISS AYANA KARA TORRENCE M.P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORRENCE
Provider First Name:
AYANA
Provider Middle Name:
KARA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.P.T
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:
1174839062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 CLOVELLY ST APT 1303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-6939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-870-3087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4511 ROBOSSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-922-1910
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2010

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: 2251G0304X , with the licence number:  22529 , 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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