1912960337 NPI number — MARYLAND DIGESTIVE DISEASE CENTER

Table of content: (NPI 1912960337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912960337 NPI number — MARYLAND DIGESTIVE DISEASE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND DIGESTIVE DISEASE CENTER
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:
1912960337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7350 VAN DUSEN RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-5263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-498-5500
Provider Business Mailing Address Fax Number:
301-498-7346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7610 CARROLL AVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
TAKOMA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20912-6384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-270-3640
Provider Business Practice Location Address Fax Number:
301-270-3645
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALIE
Authorized Official First Name:
GEORGIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
301-498-5500

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 085HMA . This is a "CAREFIRST BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 213681300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: A113 . This is a "CAREFIRST BCBS DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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