1477886802 NPI number — STEPHEN R. DAMM, M.D., P.A.

Table of content: (NPI 1477886802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477886802 NPI number — STEPHEN R. DAMM, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN R. DAMM, M.D., P.A.
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:
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:
1477886802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9811 MALLARD DR
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20708-3143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-776-2818
Provider Business Mailing Address Fax Number:
301-369-3409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9811 MALLARD DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20708-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-776-2818
Provider Business Practice Location Address Fax Number:
301-369-3409
Provider Enumeration Date:
09/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DAMM
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-776-2818

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  D0020680 , 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: 0222 . This is a "BCBS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2634SR . This is a "BSBSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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