Provider Demographics
NPI:1033532460
Name:DR. NANCY'S HOUSECALLS
Entity Type:Organization
Organization Name:DR. NANCY'S HOUSECALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:DENNISSE
Authorized Official - Last Name:RIVERA-KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-353-9323
Mailing Address - Street 1:1209A MARDA LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1706
Mailing Address - Country:US
Mailing Address - Phone:410-353-9323
Mailing Address - Fax:410-741-3870
Practice Address - Street 1:1209A MARDA LN
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1706
Practice Address - Country:US
Practice Address - Phone:410-353-9323
Practice Address - Fax:410-741-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040904261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD98096Medicare UPIN