1316937329 NPI number — MS. ANN MARIE BUTTERWORTH CRNP

Table of content: MS. ANN MARIE BUTTERWORTH CRNP (NPI 1316937329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316937329 NPI number — MS. ANN MARIE BUTTERWORTH CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTTERWORTH
Provider First Name:
ANN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1316937329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 RESEARCH PARK DR FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-4873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-247-5602
Provider Business Mailing Address Fax Number:
410-242-1756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 MAIDEN CHOICE LN
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:
21228-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-247-5602
Provider Business Practice Location Address Fax Number:
410-242-1756
Provider Enumeration Date:
10/21/2005

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: 363L00000X , with the licence number:  R082382 , 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: 960702100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138CSE-60656501 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 238200800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: T016-0028 . This is a "BCBS-DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0943ER-606565-02 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138CER-606565-01 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60656501 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".




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