1255379780 NPI number — KRISTY RECEK MPT

Table of content: KRISTY RECEK MPT (NPI 1255379780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255379780 NPI number — KRISTY RECEK MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RECEK
Provider First Name:
KRISTY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1255379780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 BARRYMORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-6973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-663-6450
Provider Business Mailing Address Fax Number:
410-663-6451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7672 BELAIR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-4088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-663-6450
Provider Business Practice Location Address Fax Number:
410-663-6451
Provider Enumeration Date:
06/04/2006

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: 225100000X , with the licence number:  20658 , 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: 4846270001 . This is a "DME POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522248150 . This is a "IHP, COVENTRY, UNITED HC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2144336 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350342400 . This is a "OWCP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 51647 . This is a "TRICARE, EHP, PRIORITY PA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2144336 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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