1265601843 NPI number — GREGORY LAWRENCE LAMB NBC-HIS

Table of content: GREGORY LAWRENCE LAMB NBC-HIS (NPI 1265601843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265601843 NPI number — GREGORY LAWRENCE LAMB NBC-HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMB
Provider First Name:
GREGORY
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NBC-HIS
Provider Gender Code:
M

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:
1265601843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13802 WEAVER AVE
Provider Second Line Business Mailing Address:
PO BOX 638
Provider Business Mailing Address City Name:
MAUGANSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21767-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-766-4327
Provider Business Mailing Address Fax Number:
301-766-4455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13802 WEAVER AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUGANSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21767-0638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-766-4327
Provider Business Practice Location Address Fax Number:
301-766-4455
Provider Enumeration Date:
02/27/2008

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: 237700000X , with the licence number:  2615 , 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: 40VF . This is a "BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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