1790805968 NPI number — JAROSLAW HEPEL MD

Table of content: JAROSLAW HEPEL MD (NPI 1790805968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790805968 NPI number — JAROSLAW HEPEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEPEL
Provider First Name:
JAROSLAW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1790805968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64984
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:
21264-4984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-849-2540
Provider Business Mailing Address Fax Number:
443-849-2595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 1400
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-6808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-849-2540
Provider Business Practice Location Address Fax Number:
443-849-2595
Provider Enumeration Date:
03/30/2007

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: 2085R0001X , with the licence number:  223280 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: MD13055 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: D0069026 , 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: 022366200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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