1215090402 NPI number — DAMIAN E BIRCHESS MD ET AL PTR CHRISTINE L COMMERFORD MD

Table of content: (NPI 1215090402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215090402 NPI number — DAMIAN E BIRCHESS MD ET AL PTR CHRISTINE L COMMERFORD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAMIAN E BIRCHESS MD ET AL PTR CHRISTINE L COMMERFORD MD
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:
1215090402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5411 OLD FREDERICK RD
Provider Second Line Business Mailing Address:
SUITE 18
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21229-2195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-788-4800
Provider Business Mailing Address Fax Number:
410-788-6701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5411 OLD FREDERICK RD
Provider Second Line Business Practice Location Address:
SUITE 18
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229-2195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-788-4800
Provider Business Practice Location Address Fax Number:
410-788-6701
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIRCHESS
Authorized Official First Name:
DAMIAN
Authorized Official Middle Name:
EDWIN
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
410-788-4800

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A731DE . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R828 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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