1245427392 NPI number — LAWRENCE W. ADLER MD PA

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 1245427392 NPI number — LAWRENCE W. ADLER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE W. ADLER MD PA
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:
1245427392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7310 RITCHIE HWY.
Provider Second Line Business Mailing Address:
SUITE 512
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-761-7042
Provider Business Mailing Address Fax Number:
410-761-7984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7310 RITCHIE HWY.
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-761-7042
Provider Business Practice Location Address Fax Number:
410-761-7984
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADLER
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-761-7042

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D19454 , 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: 404484300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4323821 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1993LA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W714 . This is a "BLUECHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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