1619235181 NPI number — DR. RALPH LYNWOOD SHUMAKE JR. P.D.

Table of content: DR. RALPH LYNWOOD SHUMAKE JR. P.D. (NPI 1619235181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619235181 NPI number — DR. RALPH LYNWOOD SHUMAKE JR. P.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMAKE
Provider First Name:
RALPH
Provider Middle Name:
LYNWOOD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
P.D.
Provider Gender Code:
M

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:
1619235181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9145 GUILFORD RD
Provider Second Line Business Mailing Address:
#160
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21046-1883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-490-2353
Provider Business Mailing Address Fax Number:
301-490-2376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9145 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:
21046-1883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-490-2353
Provider Business Practice Location Address Fax Number:
301-490-2376
Provider Enumeration Date:
05/02/2012

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: 183500000X , with the licence number:  09764 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 0202004627 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835N1003X , with the licence number: 09764 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835P0018X , with the licence number: 09764 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P1200X , with the licence number: 09764 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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