1184670523 NPI number — BARBARA ROGERS CRNA

Table of content: BARBARA ROGERS CRNA (NPI 1184670523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184670523 NPI number — BARBARA ROGERS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
BARBARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1184670523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1122 KENILWORTH DRIVE
Provider Second Line Business Mailing Address:
SUITE 317
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-2146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-296-4616
Provider Business Mailing Address Fax Number:
410-337-5068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 KENILWORTH DR
Provider Second Line Business Practice Location Address:
SUITE 317
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-296-4616
Provider Business Practice Location Address Fax Number:
410-337-5068
Provider Enumeration Date:
05/26/2006

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: 367500000X , with the licence number:  RN358481L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R078973 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01312471 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101572VKC . This is a "NOVITAS MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101621261 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553301500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 572480ZCXJ . This is a "NOVITAS MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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