1356539548 NPI number — MEMORIAL PSYCHOSOCIAL ASSOCIATES INC

Table of content: GAYE MOORE DOUGLAS FNP (NPI 1396719258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356539548 NPI number — MEMORIAL PSYCHOSOCIAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL PSYCHOSOCIAL ASSOCIATES INC
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:
6
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:
1356539548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
744 DULANEY VALLEY ROAD
Provider Second Line Business Mailing Address:
SUITE 17
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-825-2009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
744 DULANEY VALLEY ROAD
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-825-2009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRAUSS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-825-2009

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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