1780853325 NPI number — SHORE PSYCHIATRIC ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780853325 NPI number — SHORE PSYCHIATRIC ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORE PSYCHIATRIC ASSOCIATES, 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:
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:
1780853325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8221 TEAL DR
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-7227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-820-4005
Provider Business Mailing Address Fax Number:
410-820-4008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8221 TEAL DR
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-7227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-820-4005
Provider Business Practice Location Address Fax Number:
410-820-4008
Provider Enumeration Date:
02/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
410-820-4005

Provider Taxonomy Codes

  • Taxonomy code: 103TP0016X , with the licence number:  D0040200 , 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: 260019170 . This is a "PALMETTO GBA-RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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