1720844004 NPI number — MRS. MARIE BERNADETTE WINGFIELD RDH, BSDH

Table of content: MRS. MARIE BERNADETTE WINGFIELD RDH, BSDH (NPI 1720844004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720844004 NPI number — MRS. MARIE BERNADETTE WINGFIELD RDH, BSDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINGFIELD
Provider First Name:
MARIE
Provider Middle Name:
BERNADETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDH, BSDH
Provider Gender Code:
F

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:
1720844004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13213 CHOPTANK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLE RIVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21220-1106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-271-2042
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7650 BELAIR RD
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:
21236-4088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-668-5151
Provider Business Practice Location Address Fax Number:
410-661-5055
Provider Enumeration Date:
02/26/2024

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: 124Q00000X , with the licence number:  6704 , 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)





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