1912930835 NPI number — FITNESS FORUM OF MARYLAND, LLC

Table of content: (NPI 1912930835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912930835 NPI number — FITNESS FORUM OF MARYLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FITNESS FORUM 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:
1912930835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
659 S SALISBURY BLVD
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-5453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-831-3226
Provider Business Mailing Address Fax Number:
410-572-4041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2448 HOLLY AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-295-4941
Provider Business Practice Location Address Fax Number:
410-295-5207
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALDWIN
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
REGIONAL MANAGER
Authorized Official Telephone Number:
410-831-3226

Provider Taxonomy Codes

  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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