1578658274 NPI number — WENDY L DUBIN M.D.

Table of content: WENDY L DUBIN M.D. (NPI 1578658274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578658274 NPI number — WENDY L DUBIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBIN
Provider First Name:
WENDY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1578658274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 FAIRMOUNT AVE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-5457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-494-7921
Provider Business Mailing Address Fax Number:
410-902-8247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 FAIRMOUNT AVE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21286-5466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-494-1662
Provider Business Practice Location Address Fax Number:
410-494-1718
Provider Enumeration Date:
10/04/2006

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: 207RC0200X , with the licence number:  D0040690 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: D0040690 , 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: 0015 E554 . This is a "BLUE CHOICE/FEP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 84127601 420A . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 298739 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1949225 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290012459 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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