| NPI |
1154451094 |
|
| Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Organization Name Legal Business Name |
ANNAPOLIS PEDIATRICS PA |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider Other Organization Name |
ANNAPOLIS PEDIATRICS |
Other name by which the organization provider is or has been known. |
| Provider Other Organization Name Type Code |
3 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider First Line Business Practice Location Address |
200 FORBES ST |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Second Line Business Practice Location Address |
SUITE 200 |
|
| Provider Business Practice Location Address City Name |
ANNAPOLIS |
|
| Provider Business Practice Location Address State Name |
MD |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Business Practice Location Address Postal Code |
214011538 |
|
| Provider Business Practice Location Address Country Code If outside U S |
US |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Provider Business Practice Location Address Telephone Number |
4102636363 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
4102634086 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
3/7/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
6/13/2008 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
FORTIER |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name |
DWIGHT |
The first name of the authorized official. |
| Authorized Official Middle Name |
NORBERT |
The middle name of the authorized official. |
| Authorized Official Title or Position |
MANAGING PARTNER |
The title or position of the authorized official. |
| Authorized Official Telephone Number |
4102636363 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
208000000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider License Number 1 |
D0008188 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 |
MD |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Organization Subpart |
N |
|
| Authorized Official Name Prefix Text |
DR. |
|
| Authorized Official Credential Text |
MD |
|
| Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|