1487738027 NPI number — ABOVE (B2)

Table of content: (NPI 1487738027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487738027 NPI number — ABOVE (B2)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABOVE (B2)
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:
1487738027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-0725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-332-4260
Provider Business Mailing Address Fax Number:
410-269-0510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 BRANDERMILL BOULEVARD
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
GAMBRILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21054-1691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-224-6483
Provider Business Practice Location Address Fax Number:
410-224-6404
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRESNAHAN
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CHIEF OPERATING OPERATOR
Authorized Official Telephone Number:
443-332-4260

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  D0013889 , 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: 2126604 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411891000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 408102100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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