Provider Demographics
NPI:1689952830
Name:ANNAPOLIS RHEUMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ANNAPOLIS RHEUMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-897-8485
Mailing Address - Street 1:49 OLD SOLOMONS ISLAND RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3854
Mailing Address - Country:US
Mailing Address - Phone:410-897-8485
Mailing Address - Fax:410-897-8480
Practice Address - Street 1:49 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3854
Practice Address - Country:US
Practice Address - Phone:410-897-8485
Practice Address - Fax:410-897-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD122961300Medicaid
MD214RMedicare PIN
MD122961300Medicaid