Provider Demographics
NPI:1760694624
Name:LUNG ASSOCIATES OF ANNE ARUNDEL PC
Entity Type:Organization
Organization Name:LUNG ASSOCIATES OF ANNE ARUNDEL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STENCIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-553-8254
Mailing Address - Street 1:305 HOSPITAL DR
Mailing Address - Street 2:SUITE 305 TATE CENTER
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5805
Mailing Address - Country:US
Mailing Address - Phone:410-768-3701
Mailing Address - Fax:410-766-0881
Practice Address - Street 1:305 HOSPITAL DR
Practice Address - Street 2:SUITE 305 TATE CENTER
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5805
Practice Address - Country:US
Practice Address - Phone:410-768-3701
Practice Address - Fax:410-766-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD355300100Medicaid
DCJ466OtherBCBS DC GROUP NUMBER
MDM846OtherAMERICAID GROUP NUMBER
MD5583302OtherAETNA GROUP NUMBER
MD1399630OtherUNITED HEALTH CARE GROUP
MDKY91OtherBCBS MD GROUP NUMBER
MD5583302OtherAETNA GROUP NUMBER
MDCC6235Medicare ID - Type UnspecifiedRR MEDICARE GROUP NUMBER