1154400372 NPI number — DRS MAGGIN MARGOLIS MOY AND TADIKONDA LLC

Table of content: (NPI 1154400372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154400372 NPI number — DRS MAGGIN MARGOLIS MOY AND TADIKONDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS MAGGIN MARGOLIS MOY AND TADIKONDA LLC
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:
1154400372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13952 BALTIMORE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-490-1990
Provider Business Mailing Address Fax Number:
301-490-8750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13952 BALTIMORE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-490-1990
Provider Business Practice Location Address Fax Number:
301-490-8750
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARGOLIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
NEIL
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
301-490-1990

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 269511100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7663 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".




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