Provider Demographics
NPI:1326052515
Name:WEST, IAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2792
Mailing Address - Country:US
Mailing Address - Phone:410-643-3410
Mailing Address - Fax:410-643-3461
Practice Address - Street 1:1630 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2792
Practice Address - Country:US
Practice Address - Phone:410-643-3410
Practice Address - Fax:410-643-3461
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20621225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD102255320OtherACS/DOL PROVIDER #
MD61671003OtherCAREFIRST BCBS PROVIDER #
MD290981OtherMAMSI PROVIDER NUMBER
MDPT20621OtherPT LICENSE NUMBER
MD616428OtherBCBS OF MD PROVIDER #
MD4761-0175OtherCAREFIRST BLUE CHOICE
MD4761-0175OtherCAREFIRST BLUE CHOICE