1447732748 NPI number — TUERK HOUSE, INC

Table of content: DR. MICHELE MARIE NEWCOMER DC (NPI 1992886790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447732748 NPI number — TUERK HOUSE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUERK HOUSE, INC
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:
1447732748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 N ASHBURTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21216-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-233-0684
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5665 PURDUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21239-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-233-0684
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LYLE
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR BILLING CLERK
Authorized Official Telephone Number:
410-233-0684

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  902140 , 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: 902140 . This is a "OFFICE OF HEALTH CARE QUALITY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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