1184747479 NPI number — CIMAGLIA FOOT CARE, PLLC

Table of content: (NPI 1184747479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184747479 NPI number — CIMAGLIA FOOT CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIMAGLIA FOOT CARE, PLLC
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:
CATHY A CIMAGLIA, DPM
Provider Other Organization Name Type Code:
3
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:
1184747479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 NORTH 4TH STREET, SUITE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21550-1371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-533-2940
Provider Business Mailing Address Fax Number:
301-533-2942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 NORTH 4TH STREET, SUITE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21550-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-533-2940
Provider Business Practice Location Address Fax Number:
301-533-2942
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CIMAGLIA
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT-OWNER
Authorized Official Telephone Number:
301-533-2940

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  01261 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 00337 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 61489306 KFT9 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1255339511 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 616600800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7308039MD2 . This is a "MAMSI-MDIPA-OPTCHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0100089000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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