1285763276 NPI number — MICHAEL S. MORRIS M.D., LLC

Table of content: (NPI 1285763276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285763276 NPI number — MICHAEL S. MORRIS M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL S. MORRIS M.D., 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:
1285763276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14955 SHADY GROVE RD
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-8700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-279-7522
Provider Business Mailing Address Fax Number:
301-279-9010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14955 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-279-7522
Provider Business Practice Location Address Fax Number:
301-279-9010
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-279-7522

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  D0030027 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X , with the licence number: MD17378 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5120441 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0M45MS . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 552180 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 41520001 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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