1548269343 NPI number — DR. KARL DERIVAS HOLSCHUH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548269343 NPI number — DR. KARL DERIVAS HOLSCHUH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HOLSCHUH

Provider First Name:

KARL

Provider Middle Name:

DERIVAS

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1548269343

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/12/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 64501

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BALTIMORE

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21264-4501

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-280-6549

Provider Business Mailing Address Fax Number:

410-280-6515

Provider First Line Business Practice Location Address:

2001 MEDICAL PKWY

Provider Second Line Business Practice Location Address:

2ND FLOOR DONNER PAVILION

Provider Business Practice Location Address City Name:

ANNAPOLIS

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21401-3280

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

443-481-3300

Provider Business Practice Location Address Fax Number:

443-481-3315

Provider Enumeration Date:

07/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208G00000X , with the licence number:  D20731 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 607156001 . This is a "FEDERAL WORKMAN'S COMP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 61617 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 67820 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 0001 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
• Identifier: 265321400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 3166605 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 110980 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 15123 . This is a "JHHC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 1800584 . This is a "AMERICHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 4128365 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 41526903 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".