Provider Demographics
NPI:1033347877
Name:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, PA.,
Entity Type:Organization
Organization Name:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, PA.,
Other - Org Name:PULMONARY DISEASE AND CRITICAL CARE ASSOC CENTER FOR SLEEP DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYANJOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-997-5944
Mailing Address - Street 1:10710 CHARTER DRIVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3260
Mailing Address - Country:US
Mailing Address - Phone:410-997-5944
Mailing Address - Fax:410-997-1720
Practice Address - Street 1:8600 SNOWDEN RIVER PKWY
Practice Address - Street 2:202
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1982
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-997-1720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-01
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
159376Medicare PIN