Provider Demographics
NPI:1912929639
Name:CENTER FOR OCCUPATIONAL AND ENVIRONMENTAL NEUROLOGY
Entity Type:Organization
Organization Name:CENTER FOR OCCUPATIONAL AND ENVIRONMENTAL NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-433-2077
Mailing Address - Street 1:2 HAMILL RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1815
Mailing Address - Country:US
Mailing Address - Phone:413-433-2077
Mailing Address - Fax:410-433-0622
Practice Address - Street 1:2 HAMILL RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BALTO
Practice Address - State:MD
Practice Address - Zip Code:21210-1815
Practice Address - Country:US
Practice Address - Phone:413-433-2077
Practice Address - Fax:410-433-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD234242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T4310002OtherBLUECHOICE
T4310002OtherFEDERAL
11850OtherJOHNS HOPKINS EMPLOYEE HE
30396001OtherCAREFIRST BLUECROSS BLUES
MDT4310001OtherCAREFIRST FEDERAL
2227527OtherAETNA HMO
MD328941901Medicaid
MD240256OtherMAMSI
MD4138503 NON HMOOtherAETNA
0865690006OtherCIGNA
MD748305-29OtherCAREFIRST BLUECROSS BLUESHIELD
MDT4310001OtherBLUECHOICE
MD4138503 NON HMOOtherAETNA
T4310002OtherFEDERAL