1952480733 NPI number — DR. WILFRED R EHRMANTRAUT JR. MD

Table of content: DR. WILFRED R EHRMANTRAUT JR. MD (NPI 1952480733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952480733 NPI number — DR. WILFRED R EHRMANTRAUT JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EHRMANTRAUT
Provider First Name:
WILFRED
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
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:
1952480733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 HOSPITAL RD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-4040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-414-9844
Provider Business Mailing Address Fax Number:
410-414-9795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 SHERRY LN
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-3275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-414-9844
Provider Business Practice Location Address Fax Number:
410-414-9795
Provider Enumeration Date:
11/03/2006

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: 208200000X , with the licence number:  D0059299 , 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: 2956889 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 41312102 . This is a "RENDERING BC/BS ID# MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 401242900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1300392 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7534379 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G616-0001 . This is a "FEDERAL/DC/BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3102788 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KDC3 . This is a "CAREFIRST MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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