1962440255 NPI number — JOHN WESOLOWSKI C.R.N.A.

Table of content: JOHN WESOLOWSKI C.R.N.A. (NPI 1962440255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962440255 NPI number — JOHN WESOLOWSKI C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESOLOWSKI
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
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:
1962440255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20725-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-340-3705
Provider Business Mailing Address Fax Number:
410-827-7673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
289 HICKORY RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21658-1392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-340-3705
Provider Business Practice Location Address Fax Number:
410-827-7673
Provider Enumeration Date:
06/02/2006

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: 367500000X , with the licence number:  R078019 , 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: NA96 . This is a "CARE FIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K230 . This is a "CARE FIRST BC/BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: P00099944 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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