Provider Demographics
NPI:1629257506
Name:CENTER FOR ALLERGIC DISEASES LLC
Entity Type:Organization
Organization Name:CENTER FOR ALLERGIC DISEASES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMPSON
Authorized Official - Middle Name:B
Authorized Official - Last Name:SARPONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-931-0092
Mailing Address - Street 1:10756 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2513
Mailing Address - Country:US
Mailing Address - Phone:301-931-0092
Mailing Address - Fax:301-595-0359
Practice Address - Street 1:10756 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2513
Practice Address - Country:US
Practice Address - Phone:301-931-0092
Practice Address - Fax:301-595-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039249207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD068951300Medicaid