1750668901 NPI number — EATING DISORDERS CENTER OF COLUMBIA MARYLAND

Table of content: MS. KATHERINE ELIZABETH BOGART PHYSICIAN ASSISTANT (NPI 1780710764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750668901 NPI number — EATING DISORDERS CENTER OF COLUMBIA MARYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EATING DISORDERS CENTER OF COLUMBIA MARYLAND
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:
1750668901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9192 RED BRANCH RD
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9192 RED BRANCH RD
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-299-2272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WALEN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
410-299-2272

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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