1891907457 NPI number — LEDNUM'S JEWELERS, INC.

Table of content: (NPI 1891907457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891907457 NPI number — LEDNUM'S JEWELERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEDNUM'S JEWELERS, INC.
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:
6
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:
1891907457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 POPLAR ST
Provider Second Line Business Mailing Address:
LEDNUM BUILDING
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21613-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-228-1676
Provider Business Mailing Address Fax Number:
410-228-7464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 POPLAR ST
Provider Second Line Business Practice Location Address:
LEDNUM BUILDING
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21613-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-228-1676
Provider Business Practice Location Address Fax Number:
410-228-7464
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEDNUM
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
NOBLE
Authorized Official Title or Position:
AUDIOLOGIST/SECRETARY
Authorized Official Telephone Number:
443-521-0576

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  2201 001234 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 2101 001488 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 01059 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 2101 000030 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 02-0000132 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 01025 , 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: L204 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 226020 . This is a "MAMSI UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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