1114368222 NPI number — DR. GEORGE T DOOLEY R. PH.

Table of content: DR. GEORGE T DOOLEY R. PH. (NPI 1114368222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114368222 NPI number — DR. GEORGE T DOOLEY R. PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOOLEY
Provider First Name:
GEORGE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
R. PH.
Provider Gender Code:
M

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:
1114368222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 RUSSET CT
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:
21221-3210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-574-6470
Provider Business Mailing Address Fax Number:
410-574-0712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 RUSSET CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21221-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-574-6470
Provider Business Practice Location Address Fax Number:
410-574-0712
Provider Enumeration Date:
07/17/2013

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: 183500000X , with the licence number:  7293 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 0202211118 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com