1851499768 NPI number — DR. DOROTHY H KURTZ PHELAN D.P.M.

Table of content: DR. DOROTHY H KURTZ PHELAN D.P.M. (NPI 1851499768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851499768 NPI number — DR. DOROTHY H KURTZ PHELAN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTZ PHELAN
Provider First Name:
DOROTHY
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KURTZ
Provider Other First Name:
DOROTHY
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851499768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 EXECUTIVE DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-536-7850
Provider Business Mailing Address Fax Number:
978-536-7851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BROOKSBY VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-536-7850
Provider Business Practice Location Address Fax Number:
978-536-7851
Provider Enumeration Date:
09/21/2006

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: 213E00000X , with the licence number:  POD1030 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 2374 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200148199 . This is a "TAX ID #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 03Y002802ME02 . This is a "ANTHEM NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 22010099 . This is a "MAINECARE IND#" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 060678 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1841270642 . This is a "GROUP NPI#" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1851499768 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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