Provider Demographics
NPI:1528171840
Name:DOCTORS EMERGENCY SERVICE, PA
Entity type:Organization
Organization Name:DOCTORS EMERGENCY SERVICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-481-1366
Mailing Address - Street 1:9900 FRANKLIN SQUARE DR STE B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5915
Mailing Address - Country:US
Mailing Address - Phone:410-931-0400
Mailing Address - Fax:
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS464DOOtherBLUE SHIELD
DCT239OtherGHI
MD90530Medicaid
MDS464DOOtherBLUE SHIELD
MD90530Medicaid