Provider Demographics
NPI:1972276020
Name:AVANTI CRANIAL PROSTHESIS RX
Entity Type:Organization
Organization Name:AVANTI CRANIAL PROSTHESIS RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRCETOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:443-850-0693
Mailing Address - Street 1:10451 MILL RUN CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5594
Mailing Address - Country:US
Mailing Address - Phone:410-487-4376
Mailing Address - Fax:443-345-8298
Practice Address - Street 1:10451 MILL RUN CIR STE 400
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5594
Practice Address - Country:US
Practice Address - Phone:410-487-4376
Practice Address - Fax:443-345-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier