Provider Demographics
NPI:1386832772
Name:JEREMY M DRELICH
Entity Type:Organization
Organization Name:JEREMY M DRELICH
Other - Org Name:ALLEGANY ALLERGY AND ASTHMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DRELICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-777-3300
Mailing Address - Street 1:301 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2828
Mailing Address - Country:US
Mailing Address - Phone:301-777-3300
Mailing Address - Fax:301-777-3595
Practice Address - Street 1:301 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2828
Practice Address - Country:US
Practice Address - Phone:301-777-3300
Practice Address - Fax:301-777-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046243207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD289LMedicare PIN