1306821665 NPI number — RALPH MARCOOT DDS

Table of content: RALPH MARCOOT DDS (NPI 1306821665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306821665 NPI number — RALPH MARCOOT DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCOOT
Provider First Name:
RALPH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1306821665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 191
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCESS ANNE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21853-0191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-651-9852
Provider Business Mailing Address Fax Number:
410-651-1279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12137 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCESS ANNE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21853-1358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-651-9852
Provider Business Practice Location Address Fax Number:
410-651-1279
Provider Enumeration Date:
12/09/2005

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: 1223S0112X , with the licence number:  4832 , 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: 4832 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521860379 . This is a "DELTA DENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 054635 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 190081 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9179128 . This is a "DORAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119591300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG26TH 521860379-03 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 288504201 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 521860379 . This is a "METLIFE" identifier . This identifiers is of the category "OTHER".




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