1740530534 NPI number — DR. MAXIM ROSARIO MB BCH BAO D.PHIL

Table of content: DR. MAXIM ROSARIO MB BCH BAO D.PHIL (NPI 1740530534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740530534 NPI number — DR. MAXIM ROSARIO MB BCH BAO D.PHIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSARIO
Provider First Name:
MAXIM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MB BCH BAO D.PHIL
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:
1740530534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9910 FRANKLIN SQUARE DRIVE SUITE 2110
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:
21236-4902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-933-6423
Provider Business Mailing Address Fax Number:
410-933-1390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 RUTLAND AVENUE RM 659
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:
21205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-362-1451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2012

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: 207ZC0006X , with the licence number:  BB4745785 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZC0006X , with the licence number: D84001 , 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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