1225343825 NPI number — MARYLAND COLORECTAL SPECIALISTS, P.A.

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 1225343825 NPI number — MARYLAND COLORECTAL SPECIALISTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND COLORECTAL SPECIALISTS, P.A.
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:
CHUKWUMA ANYADIKE, M.D., P.A.
Provider Other Organization Name Type Code:
4
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:
1225343825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
193 STONER AVE
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-5782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-751-1387
Provider Business Mailing Address Fax Number:
410-871-0603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 STONER AVE
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-751-1387
Provider Business Practice Location Address Fax Number:
410-871-0603
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ANYADIKE
Authorized Official First Name:
ADWOA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
410-751-1387

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  D0070668 , 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: 231801600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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