1285672923 NPI number — MRS. MELISSA TUTAS MSPT

Table of content: MRS. MELISSA TUTAS MSPT (NPI 1285672923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285672923 NPI number — MRS. MELISSA TUTAS MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUTAS
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

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:
1285672923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 FARM VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLSTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21047-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-414-7139
Provider Business Mailing Address Fax Number:
410-941-5057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3465 BOX HILL CORPORATE CENTER DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21009-1261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-569-4806
Provider Business Practice Location Address Fax Number:
410-569-5474
Provider Enumeration Date:
06/03/2006

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: 225100000X , with the licence number:  19053 , 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: 4842670001 . This is a "DME POS ASSIGNED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522248150 . This is a "COVENTRY HEALTHCARE OF DE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522248150 . This is a "INTEGRATED HAELTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0007263155 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2144336 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 650018560 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 401764100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51647 . This is a "EHP, KAISER, PRIORITY PAR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522248150 . This is a "TRICARE STANDARD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522248150 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T121-0001 . This is a "FED BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2144336 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 76934702 . This is a "CAREFIRST BCBS RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T121-0001 . This is a "BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 350342400 . This is a "OWCP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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