1619924263 NPI number — TARA THURLBY MUSCOVICH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619924263 NPI number — TARA THURLBY MUSCOVICH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MUSCOVICH

Provider First Name:

TARA

Provider Middle Name:

THURLBY

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1619924263

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/21/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1438 DEFENSE HIGHWAY

Provider Second Line Business Mailing Address:

SUITE 201

Provider Business Mailing Address City Name:

GAMBRILLS

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21054

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-721-3200

Provider Business Mailing Address Fax Number:

410-721-2680

Provider First Line Business Practice Location Address:

1438 DEFENSE HIGHWAY

Provider Second Line Business Practice Location Address:

SUITE 201

Provider Business Practice Location Address City Name:

GAMBRILLS

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21054

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-721-3200

Provider Business Practice Location Address Fax Number:

410-721-2680

Provider Enumeration Date:

05/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  D46992 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: OM7OTT . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 080144695 . This is a "RAILROAD RETIREMENT" identifier . This identifiers is of the category "OTHER".
• Identifier: 2216536 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 33476 . This is a "JOHNS HOPKINS HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 637917 . This is a "INFORMED" identifier . This identifiers is of the category "OTHER".
• Identifier: 1278653 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 53940001 . This is a "BLUE CROSS BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 231121600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 355138 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 38536 . This is a "COVENTRY HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 4205809 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: P13977 . This is a "BCBS MPOS" identifier . This identifiers is of the category "OTHER".
• Identifier: 355138 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 733208 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".