1386898781 NPI number — TAI DIAL DPT

Table of content: TAI DIAL DPT (NPI 1386898781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386898781 NPI number — TAI DIAL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAL
Provider First Name:
TAI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OGUNDIPE
Provider Other First Name:
TAI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386898781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10845 TOWN CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DUNKIRK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20754-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-257-5263
Provider Business Mailing Address Fax Number:
410-257-5341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-4015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-414-4846
Provider Business Practice Location Address Fax Number:
410-414-4810
Provider Enumeration Date:
11/11/2008

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: 225100000X , with the licence number:  22705 , 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: 406409701 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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