1396783320 NPI number — MICHELE ELCANO GLEITSMANN M.S., A.P.R.N., B.C.

Table of content: (NPI 1750119236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396783320 NPI number — MICHELE ELCANO GLEITSMANN M.S., A.P.R.N., B.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLEITSMANN
Provider First Name:
MICHELE
Provider Middle Name:
ELCANO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., A.P.R.N., B.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELCANO
Provider Other First Name:
MICHELE
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., A.P.R.N., B.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396783320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 630973
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21263-0973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-286-0664
Provider Business Mailing Address Fax Number:
410-286-0664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 CHANEYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
OWINGS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20736-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-286-0664
Provider Business Practice Location Address Fax Number:
410-286-0664
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: 163WP0809X , with the licence number:  R057725 , 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)





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