1346259470 NPI number — MR. CHARLES B. MAGICH JR. CRNA

Table of content: MR. CHARLES B. MAGICH JR. CRNA (NPI 1346259470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346259470 NPI number — MR. CHARLES B. MAGICH JR. CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGICH
Provider First Name:
CHARLES
Provider Middle Name:
B.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
CRNA
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:
1346259470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64795
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:
21264-4795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-328-6704
Provider Business Mailing Address Fax Number:
410-328-4124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 CORAL SPRINGS DRIVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065-4172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-837-1201
Provider Business Practice Location Address Fax Number:
954-752-1660
Provider Enumeration Date:
08/07/2006

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: 367500000X , with the licence number:  R108865 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: APRN11002490 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104763500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213307500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104763500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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