Provider Demographics
NPI: | 1437331550 |
---|---|
Name: | DRS KIME GIPSON AND SUTULA PA |
Entity Type: | Organization |
Organization Name: | DRS KIME GIPSON AND SUTULA PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF BILLING |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | MARY |
Authorized Official - Last Name: | MCDONALD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 410-350-2193 |
Mailing Address - Street 1: | 3001 S HANOVER ST |
Mailing Address - Street 2: | NA114 |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21225-1233 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-350-2112 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3001 S HANOVER ST |
Practice Address - Street 2: | NA114 |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21225-1233 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-350-2112 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-11-30 |
Last Update Date: | 2007-11-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Single Specialty |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | Group - Single Specialty |
No | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | Group - Single Specialty |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | Group - Single Specialty |
No | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | Group - Single Specialty |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Single Specialty |
No | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | Group - Single Specialty |
No | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | Group - Single Specialty |
No | 207ZN0500X | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | Group - Single Specialty |
No | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | Group - Single Specialty |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Single Specialty |
No | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | Group - Single Specialty |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Single Specialty |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | W299 | Other | MEDICARE |
MD | W299 | Other | MEDICARE |