1821027590 NPI number — MRS. SARAH RUTH HULBERT PHD

Table of content: MICHELLE TANCIO OTR (NPI 1487868535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821027590 NPI number — MRS. SARAH RUTH HULBERT PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULBERT
Provider First Name:
SARAH
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1821027590
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:
611 PARK AVE
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201-4547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-347-7744
Provider Business Mailing Address Fax Number:
410-347-7744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-4547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-347-7744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2006

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: 103TC0700X , with the licence number:  2825 , 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: GN33SR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0005651015 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: H2120001 . This is a "CAREFIRST BLUECROSS BLUES" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1406 . This is a "AMERICAN PSYCHOLOGY SYSTE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52967602 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 002619 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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