1467560383 NPI number — MIGUEL KARACUSCHANSKY M.D.

Table of content: MIGUEL KARACUSCHANSKY M.D. (NPI 1467560383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467560383 NPI number — MIGUEL KARACUSCHANSKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARACUSCHANSKY
Provider First Name:
MIGUEL
Provider Middle Name:
Provider Name Prefix Text:
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:
1467560383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E 33RD ST
Provider Second Line Business Mailing Address:
SUITE # 640
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21218-3322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-366-4441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E 33RD ST
Provider Second Line Business Practice Location Address:
SUITE # 640
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-366-4441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006

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: 207R00000X , with the licence number:  D15462 , 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: 053061100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4745M . This is a "CAREFIRST MARYALND #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 111923482 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T143 . This is a "BLUE CHOICE #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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