1578995593 NPI number — ROSHUN J HARRIS LCPC & ASSOCIATES LLC

Table of content: (NPI 1578995593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578995593 NPI number — ROSHUN J HARRIS LCPC & ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSHUN J HARRIS LCPC & ASSOCIATES LLC
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:
1578995593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2505 LORD BALTIMORE DR
Provider Second Line Business Mailing Address:
A-102
Provider Business Mailing Address City Name:
WINDSOR MILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21244-2673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-903-3178
Provider Business Mailing Address Fax Number:
410-510-1001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 WARREN RD
Provider Second Line Business Practice Location Address:
SUITE 25A
Provider Business Practice Location Address City Name:
PIKESVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-5334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-903-3178
Provider Business Practice Location Address Fax Number:
410-510-1001
Provider Enumeration Date:
08/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
ROSHUN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/ PROVIDER
Authorized Official Telephone Number:
410-903-3178

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LC3404 , 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: X9940001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3217788 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 030347000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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