1396870846 NPI number — TOD OWEN BOEHM D.C., C.C.S.P.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396870846 NPI number — TOD OWEN BOEHM D.C., C.C.S.P.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BOEHM

Provider First Name:

TOD

Provider Middle Name:

OWEN

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

D.C., C.C.S.P.

Provider Gender Code:

M

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:

1396870846

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/28/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6549 LONG BEACH DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAINT LEONARD

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20685-2541

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2855 CHESAPEAKE BCH RD W

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DUNKIRK

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20754-9530

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-257-9762

Provider Business Practice Location Address Fax Number:

410-257-9738

Provider Enumeration Date:

02/23/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 111NR0400X , with the licence number:  SO1535 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 111NS0005X , with the licence number: SO1535 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 222997060 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: F173-0001 . This is a "FEDERAL BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: F173-0001 . This is a "CAREFIRST BCBS BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: F173-0001 . This is a "CAREFIRST BCBS PREFERRED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 2037667 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 222997060 . This is a "PHCS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 4609048 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 54238101 . This is a "BCBS MD PROF RENDERING #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: M265 . This is a "CAREFIRST BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: M265 . This is a "BCBS NATIONAL CAP AREA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".