1912624669 NPI number — LANG ORTHODONTICS

Table of content: FREDERICK MICHAEL SCHEKORRA DO (NPI 1730167164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912624669 NPI number — LANG ORTHODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANG ORTHODONTICS
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:
1912624669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407 YORK RD STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-6042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-821-6458
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10030 BALTIMORE NATIONAL PIKE STE D120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLICOTT CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21042-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-461-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
410-461-2700

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 461474700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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