1497967327 NPI number — MARYLAND PHYSICAL THERAPY GROUP, INC. TA MID-TOWNE MEDICAL GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497967327 NPI number — MARYLAND PHYSICAL THERAPY GROUP, INC. TA MID-TOWNE MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND PHYSICAL THERAPY GROUP, INC. TA MID-TOWNE MEDICAL GROUP, INC.
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:
MID-TOWNE MEDICAL GROUP, INC.
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:
1497967327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 EAST MOUNT ROYAL AVE
Provider Second Line Business Mailing Address:
THE TOWNE BLDG LOWER LEVEL
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21202-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-347-3000
Provider Business Mailing Address Fax Number:
410-539-3676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 E MOUNT ROYAL AVE
Provider Second Line Business Practice Location Address:
THE TOWNE BLDG LOWER LEVEL
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-347-3000
Provider Business Practice Location Address Fax Number:
410-539-3676
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MATTHEWSON
Authorized Official First Name:
M. SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
COORDINATOR
Authorized Official Telephone Number:
410-347-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  D0006489 , 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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