1447261045 NPI number — DR. SANG CHEOL DOH M.D.

Table of content: DR. SANG CHEOL DOH M.D. (NPI 1447261045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447261045 NPI number — DR. SANG CHEOL DOH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOH
Provider First Name:
SANG
Provider Middle Name:
CHEOL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1447261045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 CRAIN HWY S
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061-5577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-760-6623
Provider Business Mailing Address Fax Number:
410-760-6624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 CRAIN HWY S
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-760-6623
Provider Business Practice Location Address Fax Number:
410-760-6624
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0019512 , 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: 252331100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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