1184813792 NPI number — GEH MEDICAL ASSOCIATES, PA

Table of content: (NPI 1184813792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184813792 NPI number — GEH MEDICAL ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEH MEDICAL ASSOCIATES, PA
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:
KENNETH GEH MD
Provider Other Organization Name Type Code:
5
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:
1184813792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21041-1280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 ARMORY PL
Provider Second Line Business Practice Location Address:
SUITE 3G
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-225-8620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEH
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
410-225-8620

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0053987 , 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: 04-04411 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: LW11GE . This is a "CAREFIRST BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2745223 . This is a "AETNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2783 . This is a "ELDERHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: FO81 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 007201000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022803 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 298110 . This is a "MAMSI HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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