1578593273 NPI number — DENNIS ODIE M.D.

Table of content: DENNIS ODIE M.D. (NPI 1578593273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578593273 NPI number — DENNIS ODIE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODIE
Provider First Name:
DENNIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1578593273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9106 PHILADELPHIA ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237-4329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-780-1980
Provider Business Mailing Address Fax Number:
410-780-1984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9106 PHILADELPHIA ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-780-1980
Provider Business Practice Location Address Fax Number:
410-780-1984
Provider Enumeration Date:
07/05/2006

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: 207R00000X , with the licence number:  D0055306 , 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: 7944212 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012403600 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 013868 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0P94DH 61009606 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 537R . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: H34457 . This is a "MEDICARE UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0404280 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 013868 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 013868 . This is a "EMPLOYERS HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 673115 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7396509 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0P94DH 61009605 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110221459 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 21D1019527 . This is a "CLIA NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2579562 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: S206 0001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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