1902088917 NPI number — MRS. OLGA DANA POLITES M.S., CCC-SLP

Table of content: MRS. OLGA DANA POLITES M.S., CCC-SLP (NPI 1902088917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902088917 NPI number — MRS. OLGA DANA POLITES M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLITES
Provider First Name:
OLGA
Provider Middle Name:
DANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAKRES-POLITES
Provider Other First Name:
OLGA
Provider Other Middle Name:
DANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902088917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 METRO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-318-6780
Provider Business Mailing Address Fax Number:
410-318-6759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 METRO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-318-6780
Provider Business Practice Location Address Fax Number:
410-318-6759
Provider Enumeration Date:
11/30/2007

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: 235Z00000X , with the licence number:  01049 , 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: 354055-02 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 354055-04 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 545414-01 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J175-0012 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 545414-02 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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