1760024681 NPI number — MRS. COLLEEN WOLF-FISHER TSIKERDANOS C.G.C.

Table of content: MRS. COLLEEN WOLF-FISHER TSIKERDANOS C.G.C. (NPI 1760024681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760024681 NPI number — MRS. COLLEEN WOLF-FISHER TSIKERDANOS C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TSIKERDANOS
Provider First Name:
COLLEEN
Provider Middle Name:
WOLF-FISHER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHER
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
WOLF
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760024681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9902 MAIDBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-610-0980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9902 MAIDBROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-610-0980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2019

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GC001221 . This is a "GENETIC COUNSELING LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GC2019-014 . This is a "GENETIC COUNSELING LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: GC202 . This is a "GENETIC COUNSELING LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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