1427167923 NPI number — PODIATRY GROUP OF ANNAPOLIS PA

Table of content: (NPI 1427167923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427167923 NPI number — PODIATRY GROUP OF ANNAPOLIS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY GROUP OF ANNAPOLIS PA
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:
1427167923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 OLD SOLOMONS ISLAND ROAD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-0902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-224-4448
Provider Business Mailing Address Fax Number:
410-841-5200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 OLD SOLOMONS ISLAND ROAD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-0902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-224-4448
Provider Business Practice Location Address Fax Number:
443-949-9539
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-224-4448

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22570000 . This is a "FEP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 338839OC2 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339839MD2 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339839ML2 . This is a "MAMSI LIFE AND HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7076126 . This is a "AETNA TRADITIONAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22570000 . This is a "GHMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 345024PPO . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7582764 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2329307 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204300900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: C341Q . This is a "UNITED AMERICAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: LU50PO . This is a "CAREFIRST BLUECROSS BLUES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3938140001 . This is a "ADMINISTAR FEDERAL INC" identifier . This identifiers is of the category "OTHER".




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