1558487322 NPI number — ALLIANCE ORTHOPEDIC LABS, INC.

Table of content: (NPI 1558487322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558487322 NPI number — ALLIANCE ORTHOPEDIC LABS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE ORTHOPEDIC LABS, INC.
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:
1558487322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 HARRY S TRUMAN PKWY
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-224-2000
Provider Business Mailing Address Fax Number:
410-224-5696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9678 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20772-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-599-0001
Provider Business Practice Location Address Fax Number:
301-599-2040
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TINDALL
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
410-224-2000

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  02168273 , 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: MJ61AL . This is a "CAREFIRST MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 027147400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 714501200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: J5690001 . This is a "CAREFIRST NATIONAL CAP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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