1255364410 NPI number — ADRIANE STITES COSBY MS RD LDN

Table of content: ADRIANE STITES COSBY MS RD LDN (NPI 1255364410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255364410 NPI number — ADRIANE STITES COSBY MS RD LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSBY
Provider First Name:
ADRIANE
Provider Middle Name:
STITES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS RD LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STITES
Provider Other First Name:
ADRIANE
Provider Other Middle Name:
DANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS RD LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255364410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6535 N CHARLES ST
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
BALTO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-938-5252
Provider Business Mailing Address Fax Number:
410-938-5250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6535 N CHARLES ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
BALTO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-938-5252
Provider Business Practice Location Address Fax Number:
410-938-5250
Provider Enumeration Date:
07/09/2006

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: 133NN1002X , with the licence number:  D02389 , 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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