1225043763 NPI number — BUILD FELLOWSHIP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225043763 NPI number — BUILD FELLOWSHIP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUILD FELLOWSHIP, INC.
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:
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:
1225043763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2114 N CHARLES ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21218-5765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-528-0305
Provider Business Mailing Address Fax Number:
410-528-0316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-5765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-528-0305
Provider Business Practice Location Address Fax Number:
410-528-0316
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETERKA
Authorized Official First Name:
SYLVESTER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRPERSON
Authorized Official Telephone Number:
410-528-0305

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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