1053380576 NPI number — ANNE ARUNDEL MEDICAL CENTER, INC

Table of content: AMY NGUYEN (NPI 1518672021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053380576 NPI number — ANNE ARUNDEL MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNE ARUNDEL MEDICAL CENTER, INC
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:
6
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:
1053380576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64262
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-481-6576
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:
Provider Enumeration Date:
03/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VP BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
443-481-6558

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 805221 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: F125 . This is a "CAREFIRST BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 507000702 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LU71AN . This is a "CAREFIRST BCBS MD" identifier . This identifiers is of the category "OTHER".