1477503118 NPI number — MEDSTAR PHYSICIAN PARTNERS, INC

Table of content: (NPI 1477503118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477503118 NPI number — MEDSTAR PHYSICIAN PARTNERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSTAR PHYSICIAN PARTNERS, 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:
1477503118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9600 PULASKI PARK DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21220-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-574-3000
Provider Business Mailing Address Fax Number:
410-574-2261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9600 PULASKI PARK DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21220-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-574-3000
Provider Business Practice Location Address Fax Number:
410-574-2261
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KESSLER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
443-725-8762

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 035476700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB8990 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 414263200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7099 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: B016 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: KF60ME . This is a "CAREFIRST MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4300 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6003 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0176 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1777 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J484 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".




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