1407970601 NPI number — MARYLAND PHYSICIANS ASSOCIATES

Table of content: (NPI 1407970601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407970601 NPI number — MARYLAND PHYSICIANS ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND PHYSICIANS ASSOCIATES
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:
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:
1407970601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6615 REISTERSTOWN RD
Provider Second Line Business Mailing Address:
SUITE 205A
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-2686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-486-2298
Provider Business Mailing Address Fax Number:
410-358-6551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6615 REISTERSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 205A
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-2686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-486-2298
Provider Business Practice Location Address Fax Number:
410-358-6551
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VENTURA
Authorized Official First Name:
MELENCIO
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
410-486-2298

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1568545432 . This is a "NAZEMI, NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 36713002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992852933 . This is a "KOZACHUK NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1952406043 . This is a "GARIN NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1265538623 . This is a "VENTURA NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1619073111 . This is a "MOLFINO NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W4920000 . This is a "BCHOICE MD VENTURA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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