1194714857 NPI number — TAMARA S SOBEL M.D.

Table of content: TAMARA S SOBEL M.D. (NPI 1194714857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194714857 NPI number — TAMARA S SOBEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBEL
Provider First Name:
TAMARA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1194714857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 CROSSROADS DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-998-9100
Provider Business Mailing Address Fax Number:
410-998-9104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 PARK CENTER CT STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-630-1402
Provider Business Practice Location Address Fax Number:
410-356-1934
Provider Enumeration Date:
10/17/2005

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: 207R00000X , with the licence number:  D0045432 , 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: 331491000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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