1326148347 NPI number — MARYLAND PERINATAL ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326148347 NPI number — MARYLAND PERINATAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND PERINATAL ASSOCIATES
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:
1326148347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15005 SHADY GROVE RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-6340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-251-8611
Provider Business Mailing Address Fax Number:
301-251-8779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15005 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-251-8611
Provider Business Practice Location Address Fax Number:
301-251-8779
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
301-251-8611

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  D0050638 , 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: 197CMA . This is a "BCBS MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: K785 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0706806 . This is a "AMERICHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 254856 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 409486700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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