1760431852 NPI number — DR. JOEL E MAX M.D.

Table of content: DR. JOEL E MAX M.D. (NPI 1760431852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760431852 NPI number — DR. JOEL E MAX M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAX
Provider First Name:
JOEL
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1760431852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W RIDGELY RD
Provider Second Line Business Mailing Address:
STE 4B
Provider Business Mailing Address City Name:
TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-5101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-561-1960
Provider Business Mailing Address Fax Number:
410-560-3497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W RIDGELY RD
Provider Second Line Business Practice Location Address:
STE 4B
Provider Business Practice Location Address City Name:
TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-5101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-561-1960
Provider Business Practice Location Address Fax Number:
410-560-3497
Provider Enumeration Date:
05/08/2006

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: 207N00000X , with the licence number:  D47019 , 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: 248900700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KE39RO . This is a "BCBSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R270 . This is a "BSDC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CI7619 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com