1639256415 NPI number — MISS JENNIFER LYNN GLATTFELDER CPNP

Table of content: DR. RICHARD PETER MAULION M.D. (NPI 1962704080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639256415 NPI number — MISS JENNIFER LYNN GLATTFELDER CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLATTFELDER
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLATTFELDER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639256415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8114 SANDPIPER CIRCLE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-933-8101
Provider Business Mailing Address Fax Number:
410-933-8106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8114 SANDPIPER CIRCLE
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-933-8101
Provider Business Practice Location Address Fax Number:
410-933-8106
Provider Enumeration Date:
11/01/2006

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: 208000000X , with the licence number:  R143206 , 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: 4089979 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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