1528679834 NPI number — ERC MARYLAND

Table of content: MRS. DEBORAH DENISE GREEN BA, MSOT (NPI 1275757957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528679834 NPI number — ERC MARYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERC MARYLAND
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:
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:
1528679834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 561577
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80256-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7505 OSLER DR STE 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-7739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-825-8584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHEPEL
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING AND CONTRACTING MANAG
Authorized Official Telephone Number:
206-383-4781

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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