1851305148 NPI number — MRS. KERI JEANNINE SALYERS-CARROLL P.T.

Table of content: MRS. KERI JEANNINE SALYERS-CARROLL P.T. (NPI 1851305148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851305148 NPI number — MRS. KERI JEANNINE SALYERS-CARROLL P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALYERS-CARROLL
Provider First Name:
KERI
Provider Middle Name:
JEANNINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SALYERS
Provider Other First Name:
KERI
Provider Other Middle Name:
JEANNINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851305148
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:
2003 PHILLIPS TER UNIT 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-8169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-956-1574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3179 BRAVERTON ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21037-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-956-4308
Provider Business Practice Location Address Fax Number:
410-956-8038
Provider Enumeration Date:
07/29/2006

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: 225100000X , with the licence number:  20348 , 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: 57731 . This is a "JOHN HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5622033 . This is a "CCN NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 699023 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T6710017 . This is a "BLUECROSS BLUESHIELD DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2431568 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 756LL185 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 619225-02 . This is a "BLUECROSS BLUESHIELD MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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