1699725853 NPI number — WOMENS HEALTH BOUTIQUE WEINBERG CENTER

Table of content: (NPI 1699725853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699725853 NPI number — WOMENS HEALTH BOUTIQUE WEINBERG CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS HEALTH BOUTIQUE WEINBERG CENTER
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:
1699725853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 SAINT PAUL PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21202-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-332-9859
Provider Business Mailing Address Fax Number:
410-843-2068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 SAINT PAUL PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-9859
Provider Business Practice Location Address Fax Number:
410-843-2068
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
ELISA
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-332-9859

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 345926 . This is a "MAMSI/OPTIMUM CHOICE/ALLI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 51347 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MH09WO . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 699568300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81309 . This is a "NORTHWOOD NPN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F799 . This is a "FEDERAL BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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