1104928225 NPI number — ANN C MORRILL MD

Table of content: ANN C MORRILL MD (NPI 1104928225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104928225 NPI number — ANN C MORRILL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRILL
Provider First Name:
ANN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1104928225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 SANDPIPER CIR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
WHITE MARSH
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-5028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 SANDPIPER CIR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
WHITE MARSH
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-529-8334
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006

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: 207R00000X , with the licence number:  D0034931 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X , with the licence number: D34931 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 893743 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E6680001 . This is a "BCBS FED BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3516820W . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 08783000000 . This is a "PHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 29148 . This is a "COUNTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4330551 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P11190 . This is a "BCBS POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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