1013135599 NPI number — JEAN ANN BIALAS WOMENS MEDICAL

Table of content: (NPI 1013135599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013135599 NPI number — JEAN ANN BIALAS WOMENS MEDICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEAN ANN BIALAS WOMENS MEDICAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1013135599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MEMORIAL AVE
Provider Second Line Business Mailing Address:
SUITE 303 WOMENS MEDICAL
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-3765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-872-9188
Provider Business Mailing Address Fax Number:
410-872-9169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MEMORIAL AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-759-2900
Provider Business Practice Location Address Fax Number:
301-759-4850
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BIALAS
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-759-2900

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: D0051177 , 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: 1309902 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G725 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1B02JL . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 690404100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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