1467428755 NPI number — FLAHERTY TUEGEL AND GOODMAN PA

Table of content: (NPI 1467428755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467428755 NPI number — FLAHERTY TUEGEL AND GOODMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLAHERTY TUEGEL AND GOODMAN 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:
1467428755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18111 PRINCE PHILIP DR
Provider Second Line Business Mailing Address:
STE 323
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20832-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-848-8202
Provider Business Mailing Address Fax Number:
410-848-2644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18111 PRINCE PHILIP DR
Provider Second Line Business Practice Location Address:
STE 323
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20832-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-848-8202
Provider Business Practice Location Address Fax Number:
410-848-2644
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEUGEL
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL CIRECTOR
Authorized Official Telephone Number:
410-848-8202

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 831398 . This is a "UNITED HEALTHCARE(P)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 231398 . This is a "UNIITED HEALTHCARE (S)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 750471300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KX28CA . This is a "BC MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0119 . This is a "BC DC/METRO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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