Provider Demographics
NPI:1184816662
Name:PURNELL, NORMAN R
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:R
Last Name:PURNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 A. ROSS STREET
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863
Mailing Address - Country:US
Mailing Address - Phone:410-632-3296
Mailing Address - Fax:
Practice Address - Street 1:9730 HEALTHWAY DR
Practice Address - Street 2:BERLIN HEALTH CENTER
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-629-0164
Practice Address - Fax:410-629-0185
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS013Medicare UPIN