1275952020 NPI number — RUSSELL TAYLOR SUNDBY MD

Table of content: (NPI 1346045721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275952020 NPI number — RUSSELL TAYLOR SUNDBY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDBY
Provider First Name:
RUSSELL
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUNDBY
Provider Other First Name:
TAYLOR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275952020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 ORLEANS ST RM 11379
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21287-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-955-8751
Provider Business Mailing Address Fax Number:
410-955-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CENTER DR BLDG 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892-0004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-219-3758
Provider Business Practice Location Address Fax Number:
301-451-7010
Provider Enumeration Date:
04/09/2014

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: 208000000X , with the licence number:  D0085726 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0207X , with the licence number: D0085726 , 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)