1326084237 NPI number — CHARLES A MUTSCHLER PT

Table of content: CHARLES A MUTSCHLER PT (NPI 1326084237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326084237 NPI number — CHARLES A MUTSCHLER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUTSCHLER
Provider First Name:
CHARLES
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1326084237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 FAIRMOUNT AVE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-5457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-927-8768
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 CRAIN HWY S
Provider Second Line Business Practice Location Address:
302
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-768-1213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2006

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: 225100000X , with the licence number:  18819 , 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: 1679630073 . This is a "FACILITY NPI NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F8710105 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 122047 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1366307 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 091166600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 283M380F . This is a "PTAN, MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F7170001 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 396920YQ1R . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 396920YT8 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5398714 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 426681ZBEW . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 51200024 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P650023224 . This is a "MEDICARE RR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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