1003885948 NPI number — EILEEN M GARAVENTE M.D.

Table of content: EILEEN M GARAVENTE M.D. (NPI 1003885948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003885948 NPI number — EILEEN M GARAVENTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARAVENTE
Provider First Name:
EILEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1003885948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
193 STONER AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-876-3355
Provider Business Mailing Address Fax Number:
410-848-3647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 STONER AVENUE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-876-3355
Provider Business Practice Location Address Fax Number:
410-876-3355
Provider Enumeration Date:
03/14/2006

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: 207V00000X , with the licence number:  D0057370 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD071513L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30088134 . This is a "AMERIHEALTH MERCY-WMG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 039157300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10254307 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30088199 . This is a "AMERIHEALTH MERCY-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 416566 . This is a "UPMC-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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