1699789040 NPI number — DONALD NUSS M.B., CHB

Table of content: DONALD NUSS M.B., CHB (NPI 1699789040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699789040 NPI number — DONALD NUSS M.B., CHB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUSS
Provider First Name:
DONALD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.B., CHB
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:
1699789040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHILDRENS SURGICAL SPECIALTY GROUP INC
Provider Second Line Business Mailing Address:
PO BOX 631617
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21263-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-668-7703
Provider Business Mailing Address Fax Number:
757-668-8860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 CHILDRENS LN
Provider Second Line Business Practice Location Address:
SUITE 5B
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23507-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-668-7703
Provider Business Practice Location Address Fax Number:
757-668-8860
Provider Enumeration Date:
07/28/2006

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: 2086S0120X , with the licence number:  0101028132 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35862 . This is a "ALLIANCE/MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 15341 . This is a "OPTIMA/SENTARA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7906326 . This is a "NORTH CAROLINA MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 35862 . This is a "MAMSI/OPTIMUM CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4004787 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 265053 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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