Provider Demographics
NPI:1396805008
Name:ANNAPOLIS LYMPHEDEMA CENTER
Entity type:Organization
Organization Name:ANNAPOLIS LYMPHEDEMA CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-266-8010
Mailing Address - Street 1:2525 RIVA RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7437
Mailing Address - Country:US
Mailing Address - Phone:410-266-8010
Mailing Address - Fax:443-782-2498
Practice Address - Street 1:2525 RIVA RD STE 130
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7437
Practice Address - Country:US
Practice Address - Phone:410-266-8010
Practice Address - Fax:443-782-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS441OtherBLUE SHIELD OF DC
MDKBY1ANOtherBLUE SHIELD OF MARYLAND
MD3010823OtherAETNA HEALTHCARE
MD406989700Medicaid
MD50458OtherMAMSI HEALTH CARE
MD406989700Medicaid