1063558468 NPI number — DR. DAVID ANTHONY NIEGLOS M.D.

Table of content: DR. DAVID ANTHONY NIEGLOS M.D. (NPI 1063558468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063558468 NPI number — DR. DAVID ANTHONY NIEGLOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEGLOS
Provider First Name:
DAVID
Provider Middle Name:
ANTHONY
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:
1063558468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7222 BROOKFALLS TER
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:
21209-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-318-8869
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
ANNE ARUNDEL MEDICAL CENTER
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-280-2260
Provider Business Practice Location Address Fax Number:
410-280-2290
Provider Enumeration Date:
01/30/2007

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: 207L00000X , with the licence number:  D0067457 , 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)





Copyright © 2007-2024 www.npivalidator.com