1932203528 NPI number — MS. PATRICIA BLANTON BOHANDY APRN/PHM

Table of content: MS. PATRICIA BLANTON BOHANDY APRN/PHM (NPI 1932203528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932203528 NPI number — MS. PATRICIA BLANTON BOHANDY APRN/PHM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOHANDY
Provider First Name:
PATRICIA
Provider Middle Name:
BLANTON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN/PHM
Provider Gender Code:
F

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:
1932203528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6106 EDMONDSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-474-4118
Provider Business Mailing Address Fax Number:
410-884-1246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6106 EDMONDSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-474-4118
Provider Business Practice Location Address Fax Number:
410-884-1246
Provider Enumeration Date:
09/12/2006

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: 364SP0807X , with the licence number:  R040756 , 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)





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