1306968656 NPI number — ANTHONY J MOORMAN MD AND ASSOCIATES PC

Table of content: (NPI 1306968656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306968656 NPI number — ANTHONY J MOORMAN MD AND ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY J MOORMAN MD AND ASSOCIATES PC
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:
1306968656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 SPEER RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
CHESTERTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21620-1044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-810-0767
Provider Business Mailing Address Fax Number:
410-810-0769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 SPEER RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-810-0767
Provider Business Practice Location Address Fax Number:
410-810-0769
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORMAN
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
JUDE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-810-0767

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0045212 , 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: 5376AJ . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W138 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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