1891721981 NPI number — PSYCH ASSOCIATES OF MARYLAND LLC

Table of content: (NPI 1891721981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891721981 NPI number — PSYCH ASSOCIATES OF MARYLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCH ASSOCIATES OF MARYLAND LLC
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:
1891721981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1954 GREENSPRING DR STE 530
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-4192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
667-668-2566
Provider Business Mailing Address Fax Number:
443-279-0738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1447 YORK RD STE 601
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-823-6408
Provider Business Practice Location Address Fax Number:
443-279-0738
Provider Enumeration Date:
06/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TOZER
Authorized Official First Name:
COLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF STAFF
Authorized Official Telephone Number:
667-668-2566

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 252450 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 705B . This is a "BLUE CROSS MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: K452 . This is a "BLUE CROSS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 360218 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 790298000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".