Provider Demographics
NPI:1295819837
Name:ABOVE (B2)
Entity Type:Organization
Organization Name:ABOVE (B2)
Other - Org Name:RIGHTTIME MEDICAL CARE - PASADENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRESNAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-332-4260
Mailing Address - Street 1:PO BOX 6725
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-0725
Mailing Address - Country:US
Mailing Address - Phone:443-332-4260
Mailing Address - Fax:410-269-0510
Practice Address - Street 1:8125 H RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6925
Practice Address - Country:US
Practice Address - Phone:410-224-6483
Practice Address - Fax:410-224-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013889332900000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408102100Medicaid
MD411891000Medicaid
2127593OtherOTHER ID NUMBER-COMMERCIAL NUMBER