1295833341 NPI number — DR. MATTHEW A DOW DDS

Table of content: DR. MATTHEW A DOW DDS (NPI 1295833341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295833341 NPI number — DR. MATTHEW A DOW DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOW
Provider First Name:
MATTHEW
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1295833341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
438 EAST BALTIMORE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TANEYTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21787-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-756-4373
Provider Business Mailing Address Fax Number:
410-751-1774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
438 EAST BALTIMORE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANEYTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21787-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-756-4373
Provider Business Practice Location Address Fax Number:
410-751-1774
Provider Enumeration Date:
09/20/2006

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: 1223G0001X , with the licence number:  6943 , 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: 9771 . This is a "BLUE CROSS MEDICAL ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2379 . This is a "BLUE CROSS BLUE SHIEL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 413983 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 413983 . This is a "PA BS UNITED CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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