1790901825 NPI number — WALKER MERRICK DEVELOPMENTAL PEDIATRICS

Table of content: (NPI 1790901825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790901825 NPI number — WALKER MERRICK DEVELOPMENTAL PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALKER MERRICK DEVELOPMENTAL PEDIATRICS
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:
6
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:
1790901825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10630 LITTLE PATUXENT PKWY
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-995-5437
Provider Business Mailing Address Fax Number:
301-596-3364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10630 LITTLE PATUXENT PKWY
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-995-5437
Provider Business Practice Location Address Fax Number:
301-596-3364
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MERRICK
Authorized Official First Name:
HENRI
Authorized Official Middle Name:
F. WALKER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-596-3363

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  D0034745 , 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: 0778 . This is a "CAREFIRST NATIONAL CAPITA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 2711674004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07105 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: KU63 . This is a "MARYLAND CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1200527 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21910 . This is a "PRIORITY PARTNERS" identifier . This identifiers is of the category "OTHER".




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