1730570003 NPI number — SMART PAIN SURGERY CENTER AT GERMANTOWN, LLC

Table of content: MR. DANIEL JOSEPH HALSEY MSW LICSW (NPI 1174664379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730570003 NPI number — SMART PAIN SURGERY CENTER AT GERMANTOWN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMART PAIN SURGERY CENTER AT GERMANTOWN, LLC
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:
6
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:
1730570003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 DEFENSE HWY STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-527-7246
Provider Business Mailing Address Fax Number:
866-229-5063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19851 OBSERVATION DR.
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-693-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KORNBLUTH
Authorized Official First Name:
IRA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
855-527-7246

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1567 , 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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