1922152578 NPI number — SHEPPARD PRATT HEALTH SYSTEM, INC.

Table of content: (NPI 1922152578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922152578 NPI number — SHEPPARD PRATT HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEPPARD PRATT HEALTH SYSTEM, INC.
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:
6
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:
1922152578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 N CHARLES ST
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:
21204-6819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-938-3000
Provider Business Mailing Address Fax Number:
410-938-3159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 SHADYSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUITLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20746-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-702-2130
Provider Business Practice Location Address Fax Number:
301-702-4461
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KATZ
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
VP CORPORATE BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
410-938-3150

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  3960 , 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: 3960 . This is a "SCHOOL LICENSE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 411238500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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