1396968830 NPI number — J.M. WHEATLEY

Table of content: DR. REBECCA ANN GAZZANIGA M.D. (NPI 1427230911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396968830 NPI number — J.M. WHEATLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.M. WHEATLEY
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:
1396968830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 621
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-0621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-997-0191
Provider Business Mailing Address Fax Number:
301-997-0199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 ARMORY PLACE
Provider Second Line Business Practice Location Address:
SUITE 3D, ARMORY BUILDING, MARYLAND GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-997-0191
Provider Business Practice Location Address Fax Number:
301-997-0199
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CIECKA
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
301-997-0191

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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