Provider Demographics
NPI:1972838316
Name:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, P.A.
Other - Org Name:CENTER FOR SLEEP DISORDERS/BEHAVIORAL SLEEP MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYANJOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-997-5944
Mailing Address - Street 1:10724 LITTLE PATUXENT PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3249
Mailing Address - Country:US
Mailing Address - Phone:410-997-5944
Mailing Address - Fax:410-997-1720
Practice Address - Street 1:10724 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3249
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-997-1720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKQ58Medicare PIN
MD159376Medicare PIN
DCG00550Medicare PIN