1508537549 NPI number — CHARLOTTE BARTRUG PA-C

Table of content: CHARLOTTE BARTRUG PA-C (NPI 1508537549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508537549 NPI number — CHARLOTTE BARTRUG PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTRUG
Provider First Name:
CHARLOTTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1508537549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 OLD COURT RD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-6417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-653-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 OLD COURT RD STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKESVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-653-0000
Provider Business Practice Location Address Fax Number:
410-653-5531
Provider Enumeration Date:
09/21/2021

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: 363A00000X , with the licence number:  C0008208 , 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: C0008208 . This is a "LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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