1558671834 NPI number — SARA L SCOVITCH MPT

Table of content: SARA L SCOVITCH MPT (NPI 1558671834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558671834 NPI number — SARA L SCOVITCH MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOVITCH
Provider First Name:
SARA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANNABLE
Provider Other First Name:
SARA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558671834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11027 HAUGHS CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEYMAR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21757-8765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-845-6811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8965 GUILFORD RD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21046-2384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-706-3191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010

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: 2251P0200X , with the licence number:  19745 , 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)