1679510762 NPI number — JOHN R SENATORE DPM

Table of content: JOHN R SENATORE DPM (NPI 1679510762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679510762 NPI number — JOHN R SENATORE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SENATORE
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1679510762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 374
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONKTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21111-0374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-522-9749
Provider Business Mailing Address Fax Number:
443-522-9725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 N CALVERT ST
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-6514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-243-1313
Provider Business Practice Location Address Fax Number:
410-243-1368
Provider Enumeration Date:
05/31/2006

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: 213E00000X , with the licence number:  00895 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 00895 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PIN 0001 GRP E152 . This is a "BS-FEDERAL AND NCA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3159 . This is a "ELDER HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2700303 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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