1437188703 NPI number — DIABETES AND ENDOCRINOLOGY PA M SMITH

Table of content: (NPI 1437188703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437188703 NPI number — DIABETES AND ENDOCRINOLOGY PA M SMITH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETES AND ENDOCRINOLOGY PA M SMITH
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:
1437188703
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:
303 LANDING LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21921-6613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-392-9026
Provider Business Mailing Address Fax Number:
410-392-9024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 LANDING LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-6613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-392-9026
Provider Business Practice Location Address Fax Number:
410-392-9024
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
SUHAIL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-392-9026

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  D0052227 , 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: E237 . This is a "FEDERAL BCBS PIN #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 350914 . This is a "MAMSI LIFE & HEALTH PIN #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0001001402 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0477461000 . This is a "AMERIHEALTH PIN #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E237 . This is a "CAREFIRST BLUECHOIC PIN #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LL44DI . This is a "BCBS PIN #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 710656 . This is a "PERSONAL CHOICE PIN #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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