Provider Demographics
NPI:1306911995
Name:ANNAPOLIS ASTHMA PULMONARY AND SLEEP SPEC
Entity type:Organization
Organization Name:ANNAPOLIS ASTHMA PULMONARY AND SLEEP SPEC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-266-1644
Mailing Address - Street 1:2000 MEDICAL PKWY
Mailing Address - Street 2:SUITE 607
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3742
Mailing Address - Country:US
Mailing Address - Phone:410-266-1644
Mailing Address - Fax:410-266-1642
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 607
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:410-266-1644
Practice Address - Fax:410-266-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00317246OtherMEDICARE RAILROAD
MDK469Medicare PIN