1568613909 NPI number — DR. ANGELA MARYANN PANSERA D.O.

Table of content: DR. ANGELA MARYANN PANSERA D.O. (NPI 1568613909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568613909 NPI number — DR. ANGELA MARYANN PANSERA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANSERA
Provider First Name:
ANGELA
Provider Middle Name:
MARYANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1568613909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8926 WOODYARD RD
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-6718
Provider Business Mailing Address Fax Number:
301-856-6722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 OLD BRANCH AVE
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-856-6718
Provider Business Practice Location Address Fax Number:
301-856-6722
Provider Enumeration Date:
10/03/2008

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: 2085R0202X , with the licence number:  C2-0008725 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1568613909 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 447817700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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