1881641116 NPI number — DR. CORYSE V BRATHWAITE MD

Table of content: DR. CORYSE V BRATHWAITE MD (NPI 1881641116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881641116 NPI number — DR. CORYSE V BRATHWAITE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRATHWAITE
Provider First Name:
CORYSE
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
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:
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:
1881641116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12622
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-481-6469
Provider Business Mailing Address Fax Number:
443-481-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-481-1000
Provider Business Practice Location Address Fax Number:
443-481-6933
Provider Enumeration Date:
05/30/2006

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: 174400000X , with the licence number:  D46239 , 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: 5769117 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590811600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250AAA53270803 . This is a "CAREFIRST MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55880010 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116546 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6801338 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com