1326069238 NPI number — ANSON J JOSEPH - PATUXENT NEPHROLOGY ASSOC LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326069238 NPI number — ANSON J JOSEPH - PATUXENT NEPHROLOGY ASSOC LLC

Employer Identification Number (EIN):

Provider Organization Name:

ANSON J JOSEPH - PATUXENT NEPHROLOGY ASSOC 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 Other Organization Name:

Provider Other Organization Name Type Code:

6

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:

1326069238

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 2424

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PRINCE FREDERICK

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20678-2424

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-535-2985

Provider Business Mailing Address Fax Number:

410-535-0404

Provider First Line Business Practice Location Address:

205 STEEPLE CHASE DR

Provider Second Line Business Practice Location Address:

SUITE #206

Provider Business Practice Location Address City Name:

PRINCE FREDERICK

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20678-4053

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-535-2085

Provider Business Practice Location Address Fax Number:

410-535-0404

Provider Enumeration Date:

07/23/2006

Authorized Official Last Name:

JOSEPH

Authorized Official First Name:

ANSON

Authorized Official Middle Name:

JACOB

Authorized Official Title or Position:

MD

Authorized Official Telephone Number:

410-535-2085

• Taxonomy code: 207RN0300X , with the licence number:  D56161 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0J48JA . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: D56161 . This is a "MARYLAND STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 110225745 . This is a "MEDICARE RAIL ROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 391889 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 8092036.00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: F1170001 . This is a "BLUE CROSS / BLUE SHEILD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
• Identifier: M51736 . This is a "CDS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 7743275 . This is a "AETNA - PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 2683588 . This is a "AETNA - HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".