Provider Demographics
NPI:1003912866
Name:ANNAPOLIS OB/GYN ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ANNAPOLIS OB/GYN ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LATONICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-573-9530
Mailing Address - Street 1:2000 MEDICAL PKWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3745
Mailing Address - Country:US
Mailing Address - Phone:410-573-9530
Mailing Address - Fax:410-573-9569
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3745
Practice Address - Country:US
Practice Address - Phone:410-573-9530
Practice Address - Fax:410-573-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD913511100Medicaid
MDH745Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER