1245521038 NPI number — MARYLAND MEDICAL SERVICES LLC

Table of content: (NPI 1245521038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245521038 NPI number — MARYLAND MEDICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND MEDICAL SERVICES LLC
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:
1245521038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 CENTER ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21771-5443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-238-5167
Provider Business Mailing Address Fax Number:
301-685-3819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701-5345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-238-5167
Provider Business Practice Location Address Fax Number:
301-685-3819
Provider Enumeration Date:
04/27/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUDHUD
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-238-5167

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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