1780912022 NPI number — ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND LLC

Table of content: (NPI 1780912022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780912022 NPI number — ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND LLC
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:
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:
1780912022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 OLD BRANCH AVE
Provider Second Line Business Mailing Address:
SUITE #B204
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-7445
Provider Business Mailing Address Fax Number:
240-244-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10403 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE #G-07
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-856-7445
Provider Business Practice Location Address Fax Number:
240-244-1277
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KERR
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
ELISE
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
301-856-7445

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  D0060652 , 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)





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