1841336302 NPI number — BAY AREA ORTHOPAEDICS & SPORTS MEDICINE

Table of content: (NPI 1841336302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841336302 NPI number — BAY AREA ORTHOPAEDICS & SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA ORTHOPAEDICS & SPORTS MEDICINE
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:
1841336302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 CRAIN HWY S
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061-5577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-768-5050
Provider Business Mailing Address Fax Number:
410-768-7830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1521 RITCHIE HWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ARNOLD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21012-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-544-6038
Provider Business Practice Location Address Fax Number:
410-349-9940
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
410-768-5050

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KE66BA . This is a "BLUE SHIELD OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6831 . This is a "BLUE SHIELD OF DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CE3238 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 408171400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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