1790924512 NPI number — ROSS J VANANTWERP D.O., M.P.H.

Table of content: ROSS J VANANTWERP D.O., M.P.H. (NPI 1790924512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790924512 NPI number — ROSS J VANANTWERP D.O., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANANTWERP
Provider First Name:
ROSS
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O., M.P.H.
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:
1790924512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
484 RITCHIE HWY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146-2961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-544-4600
Provider Business Mailing Address Fax Number:
410-544-0997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PARK PLACE STE 325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-995-8550
Provider Business Practice Location Address Fax Number:
410-514-3582
Provider Enumeration Date:
02/18/2009

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: 207R00000X , with the licence number:  H0033830 , 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)





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