1891043006 NPI number — CPDG-AM

Table of content: (NPI 1891043006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891043006 NPI number — CPDG-AM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPDG-AM
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:
1891043006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7556 TEAGUE RD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21076-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-799-0780
Provider Business Mailing Address Fax Number:
410-799-0781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7556 TEAGUE RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21076-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-799-0780
Provider Business Practice Location Address Fax Number:
410-799-0781
Provider Enumeration Date:
08/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KOYMEN
Authorized Official First Name:
HAKAN
Authorized Official Middle Name:
OMER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-248-3384

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  12770 , 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: 036344800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022999700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 026120300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9200608 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008494860 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com