1356340053 NPI number — BERNHARD ZUNKELER MD PA

Table of content: (NPI 1356340053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356340053 NPI number — BERNHARD ZUNKELER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNHARD ZUNKELER MD PA
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:
1356340053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1122 KENILWORTH DR STE 116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-337-8201
Provider Business Mailing Address Fax Number:
410-500-4567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 KENILWORTH DR STE 116
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-337-8201
Provider Business Practice Location Address Fax Number:
410-500-4567
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZUNKELER
Authorized Official First Name:
BERNHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
410-337-8201

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  D0052426 , 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: 140006979 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 23124 . This is a "EHPJHH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2351178 . This is a "AETNA-HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 391881 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5129648 . This is a "AETNA-PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 05398 . This is a "PHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5244650004 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 112902 . This is a "CONVENTRY PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0600158 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 494347 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E6910001 . This is a "FEDERAL & BLUECHOICE BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 444100100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: OY20B . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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