1144310418 NPI number — DR. MARY ELLEN PADUSI O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144310418 NPI number — DR. MARY ELLEN PADUSI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADUSI
Provider First Name:
MARY ELLEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1144310418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 BEACON POINT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPPA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21085-4533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-679-5922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4134 E JOPPA RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NOTTINGHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-2284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-256-1006
Provider Business Practice Location Address Fax Number:
410-256-0088
Provider Enumeration Date:
10/14/2006

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: 152W00000X , with the licence number:  TA0922 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: TA0922 , 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: 613064-03 . This is a "CAREFIRST-BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 210360-121 . This is a "NVA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 50070 . This is a "DAVIS VISION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 613064-02 . This is a "CAREFIRST/ BLUE CROSS/BLU" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 940691 . This is a "EYEMED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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