1962499103 NPI number — TERRENCE XAVIER DWYER M.D.

Table of content: TERRENCE XAVIER DWYER M.D. (NPI 1962499103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962499103 NPI number — TERRENCE XAVIER DWYER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DWYER
Provider First Name:
TERRENCE
Provider Middle Name:
XAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1962499103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8926 WOODYARD RD
Provider Second Line Business Mailing Address:
SUITE 701
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-1682
Provider Business Mailing Address Fax Number:
301-856-8214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8926 WOODYARD RD
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-856-1682
Provider Business Practice Location Address Fax Number:
301-856-8214
Provider Enumeration Date:
10/03/2005

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: 207RR0500X , with the licence number:  D36294 , 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: 95423901 . This is a "CAREFIRST OF MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 168431ZAKW . This is a "MEDICARE MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0101245370 . This is a "VIRGINIA LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 157146YZW . This is a "METRO MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46950039 . This is a "CAREFIRST NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: D36294 . This is a "MARYLAND LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00887805 . This is a "RAILROAD MEDICARE INDIVIDUAL PTAN" identifier . This identifiers is of the category "OTHER".




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