1720053887 NPI number — CORRIDOR ANESTHESIA, L.L.C.

Table of content: MR. JOSEPH L. DORFLINGER LCSW (NPI 1265542575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720053887 NPI number — CORRIDOR ANESTHESIA, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORRIDOR ANESTHESIA, L.L.C.
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:
1720053887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7350 VAN DUSEN RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-5263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-498-5500
Provider Business Mailing Address Fax Number:
301-498-7346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7350 VAN DUSEN RD
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-5263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-498-5500
Provider Business Practice Location Address Fax Number:
301-498-7346
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALIE
Authorized Official First Name:
GEORGIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
301-498-5500

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 167CCO . This is a "CAREFIRST BSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DE6588 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 409316000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: K761 . This is a "CAREFIRST BSDC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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