Provider Demographics
NPI:1104891076
Name:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, PA
Entity type:Organization
Organization Name:PULMONARY DISEASE AND CRITICAL CARE ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
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 1:10710 CHARTER DRIVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3260
Mailing Address - Country:US
Mailing Address - Phone:410-997-5944
Mailing Address - Fax:410-997-1720
Practice Address - Street 1:10710 CHARTER DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3260
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-997-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKQ58Medicare PIN
MD159376Medicare PIN
DCG00550Medicare ID - Type Unspecified