Basic Information
| Provider Information | |||||||||
| NPI: | 1447341110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSTITUTE FOR ASTHMA & ALLERGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11002 VEIRS MILL RD | ||||||||
| Address2: | 414 | ||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209022574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019625800 | ||||||||
| FaxNumber: | 3019629585 | ||||||||
| Practice Location | |||||||||
| Address1: | 11002 VEIRS MILL RD | ||||||||
| Address2: | 414 | ||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209022574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019625800 | ||||||||
| FaxNumber: | 3019629585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCMATH | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3019621605 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | KP19IN | 01 | MD | CAREFIRST OF MARYLAND | OTHER | 5612207 | 01 | MD | AETNA | OTHER |