1790990927 NPI number — KATHERINE G. COLLIER D.D.S., P.A.

Table of content: (NPI 1790990927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790990927 NPI number — KATHERINE G. COLLIER D.D.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHERINE G. COLLIER D.D.S., P.A.
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:
1790990927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E EAGER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21202-5533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-502-8565
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E EAGER STREET
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:
21202-5533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-502-8565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER JOHNSON
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
410-541-4432

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 7698 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2009 . This is a "CAREFIRST BLUECROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 261864800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004418 . This is a "DORAL DENTAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 000588815 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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