1801268123 NPI number — DR. MELINDA RENEE VERTLIEB PHARMD

Table of content: DR. MELINDA RENEE VERTLIEB PHARMD (NPI 1801268123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801268123 NPI number — DR. MELINDA RENEE VERTLIEB PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERTLIEB
Provider First Name:
MELINDA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOVAK
Provider Other First Name:
MELINDA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801268123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 E CHURCHVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-420-8319
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 E CHURCHVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-420-8319
Provider Business Practice Location Address Fax Number:
410-420-9068
Provider Enumeration Date:
10/26/2015

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: 183500000X , with the licence number:  23456 , 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)