1497755300 NPI number — MARY THORSEN PT

Table of content: MARY THORSEN PT (NPI 1497755300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497755300 NPI number — MARY THORSEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORSEN
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1497755300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 BALTIMORE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-6105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-848-8628
Provider Business Mailing Address Fax Number:
410-848-3909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 W FREDERICK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKERSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21793-8230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-845-0045
Provider Business Practice Location Address Fax Number:
301-845-0045
Provider Enumeration Date:
07/21/2005

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: 225100000X , with the licence number:  17003 , 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: 322679 . This is a "MAMSI PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5060511 . This is a "AETNA NON HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: T615-0008 . This is a "CAREFIRST BLUECHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 2118118 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: H481DO-53189902 . This is a "CAREFIRST BLUECROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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