1750579074 NPI number — MORNINGSTAR & CARROLL PA

Table of content: (NPI 1750579074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750579074 NPI number — MORNINGSTAR & CARROLL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORNINGSTAR & CARROLL PA
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:
1750579074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMMITSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21727-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-447-6155
Provider Business Mailing Address Fax Number:
301-447-3289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 S SETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMITSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21727-9227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-447-6155
Provider Business Practice Location Address Fax Number:
301-447-3289
Provider Enumeration Date:
10/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-447-6156

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D0018705 , 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)

  • Identifier: 977201400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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