1922079599 NPI number — DR. IRA T FINE M.D.

Table of content: DR. IRA T FINE M.D. (NPI 1922079599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922079599 NPI number — DR. IRA T FINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINE
Provider First Name:
IRA
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1922079599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10753 FALLS RD
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-4535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-583-2828
Provider Business Mailing Address Fax Number:
410-583-2841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10753 FALLS RD
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-583-2828
Provider Business Practice Location Address Fax Number:
410-583-2841
Provider Enumeration Date:
01/31/2006

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: 174400000X , with the licence number:  D0019914 , 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: 015400 . This is a "JOHNS HOPKINS EMPLOYEE HE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 660002744 . This is a "TRAVELERS RR MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 520595110 . This is a "JOHNS HOPKINS UNIVERSITY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100588 . This is a "KAISER PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 41352406 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T6320002 . This is a "CAREFIRST FEDERAL PROVIDE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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