1013097583 NPI number — PENNIE DALTON SAVAGE CRNP

Table of content: PENNIE DALTON SAVAGE CRNP (NPI 1013097583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013097583 NPI number — PENNIE DALTON SAVAGE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVAGE
Provider First Name:
PENNIE
Provider Middle Name:
DALTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1013097583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21802-3177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-548-2343
Provider Business Mailing Address Fax Number:
844-332-3891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9715 HEALTHWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-548-2343
Provider Business Practice Location Address Fax Number:
844-332-3891
Provider Enumeration Date:
10/17/2006

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: 363L00000X , with the licence number:  R135131 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R135131 , 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: 1013097583 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613653401 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145576ZBS6 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com