1831226299 NPI number — MOLLY D PRICE MD

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 1831226299 NPI number — MOLLY D PRICE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
MOLLY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAYMONT
Provider Other First Name:
MOLLY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831226299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 DEFENSE HWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-266-9694
Provider Business Mailing Address Fax Number:
410-266-9695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 DEFENSE HWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-7069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-266-9694
Provider Business Practice Location Address Fax Number:
410-266-9695
Provider Enumeration Date:
02/27/2007

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: 2084N0400X , with the licence number:  D69091 , 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: 6197596 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9966462 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 419412800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85490003 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 961053 01 . This is a "BCBS MD" identifier . This identifiers is of the category "OTHER".




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