1629106638 NPI number — MS. PAMELA M CHANEY P.T.

Table of content: MS. PAMELA M CHANEY P.T. (NPI 1629106638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629106638 NPI number — MS. PAMELA M CHANEY P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANEY
Provider First Name:
PAMELA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1629106638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26045 SOTTERLEY HEIGHTS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20636-2659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-373-5827
Provider Business Mailing Address Fax Number:
301-373-5753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26045 SOTTERLEY HEIGHTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20636-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-373-5827
Provider Business Practice Location Address Fax Number:
301-373-5753
Provider Enumeration Date:
03/01/2007

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: 174400000X , with the licence number:  14254 , 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: 262834506 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F7CKPM . This is a "MD BCBS RENDERING PROV NO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 144037 ZCM7 . This is a "MEDICARE ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N419 . This is a "BC BS FEP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 601566700 . This is a "ACS U.S. DEPT OF LABOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 53476701 . This is a "BCBS PROFESSIONAL NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 262834506 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 987000800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: N4190001 . This is a "CAREFIRST BCBS BLUECHOICE & GHMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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