1780912022 NPI number — ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND 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 1780912022 NPI number — ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND 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:
1780912022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 OLD BRANCH AVE
Provider Second Line Business Mailing Address:
SUITE #B204
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-7445
Provider Business Mailing Address Fax Number:
240-244-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10403 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE #G-07
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-856-7445
Provider Business Practice Location Address Fax Number:
240-244-1277
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KERR
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
ELISE
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
301-856-7445

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  D0060652 , 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)





Copyright © 2007-2025 www.npivalidator.com