1376708321 NPI number — DR. ARMEL SIMO M.D.

Table of content: DR. ARMEL SIMO M.D. (NPI 1376708321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376708321 NPI number — DR. ARMEL SIMO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMO
Provider First Name:
ARMEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1376708321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4021 ZUNI CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21043-5448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-317-1609
Provider Business Mailing Address Fax Number:
443-440-5516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 MAIDEN CHOICE LN STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-5967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-216-0206
Provider Business Practice Location Address Fax Number:
443-440-5516
Provider Enumeration Date:
07/18/2008

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: 207Q00000X , with the licence number:  66074 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: D75893 , 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: 201805500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".