1467439752 NPI number — DRS MORRES GIANELLE GOERTZEN & ASSOC PA

Table of content: (NPI 1467439752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467439752 NPI number — DRS MORRES GIANELLE GOERTZEN & ASSOC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS MORRES GIANELLE GOERTZEN & ASSOC 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:
CHESAPEAKE MEDICAL SOLUTIONS TA YOUR DOC'S IN
Provider Other Organization Name Type Code:
3
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:
1467439752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 CALLOWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-334-6351
Provider Business Mailing Address Fax Number:
410-334-6352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 120TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-520-0582
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GIANELLE
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-334-6351

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  20235706 , 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: 1000038586 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD9023 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 11ZMYO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3780 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 7603709 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 408316400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2145659 . This is a "ALLIANCE ONENET" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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