1215041983 NPI number — MEDSTAR HEALTH INFUSION, INC.

Table of content: (NPI 1215041983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215041983 NPI number — MEDSTAR HEALTH INFUSION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSTAR HEALTH INFUSION, INC.
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:
1215041983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7379 WASHINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKRIDGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21075-6329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-540-4450
Provider Business Mailing Address Fax Number:
410-540-4430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7379 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21075-6329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-540-4450
Provider Business Practice Location Address Fax Number:
410-540-4430
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOTT
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-540-4419

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  PW0199 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 028880900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4540209 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1033 . This is a "BCBS OF DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62062201 . This is a "BCBS OF MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008508003 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051003300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009105352 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58886 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 953901800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2456341 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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