1194942664 NPI number — DR. THERESA MARTIN PLOG PHARMD

Table of content: DR. THERESA MARTIN PLOG PHARMD (NPI 1194942664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194942664 NPI number — DR. THERESA MARTIN PLOG PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLOG
Provider First Name:
THERESA
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
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:
1194942664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 SPRING DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-763-9093
Provider Business Mailing Address Fax Number:
410-820-9489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SHORE HEALTH SYSTEM MEMORIAL HOSPITAL
Provider Second Line Business Practice Location Address:
219 SOUTH WASHINGTON STREET
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-822-1000
Provider Business Practice Location Address Fax Number:
410-820-9489
Provider Enumeration Date:
04/19/2007

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: 183500000X , with the licence number:  16260 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: A1-0002872 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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