1861763484 NPI number — MRS. LATANYA MARONI BLACK M.A.

Table of content: MRS. LATANYA MARONI BLACK M.A. (NPI 1861763484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861763484 NPI number — MRS. LATANYA MARONI BLACK M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACK
Provider First Name:
LATANYA
Provider Middle Name:
MARONI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLACK
Provider Other First Name:
LATANYA
Provider Other Middle Name:
MARONI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861763484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5710 EXECUTIVE DR STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-744-8422
Provider Business Mailing Address Fax Number:
410-744-8424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5710 EXECUTIVE DR,
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-1759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-744-8422
Provider Business Practice Location Address Fax Number:
410-744-8424
Provider Enumeration Date:
01/13/2012

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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