1760523542 NPI number — ACTIVE DAY MD, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760523542 NPI number — ACTIVE DAY MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVE DAY MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACTIVE DAY OF BALTIMORE
Provider Other Organization Name Type Code:
3
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:
1760523542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 NESHAMINY INTERPLEX DR STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TREVOSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-6942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-642-6600
Provider Business Mailing Address Fax Number:
215-642-6610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 JOH AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-242-0379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CREAMER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-642-6600

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 409532400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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