Provider Demographics
NPI:1962620062
Name:DRS. DIMARZIO,GORDON,JACKSON,KINZER,MILLER&VERKOUW, PA
Entity type:Organization
Organization Name:DRS. DIMARZIO,GORDON,JACKSON,KINZER,MILLER&VERKOUW, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:INZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-573-1110
Mailing Address - Street 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-573-1110
Mailing Address - Fax:410-266-0714
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-573-1110
Practice Address - Fax:410-266-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDSRRGAOtherRAIL ROAD MEDICARE
MD4421835OtherAETNA
MDS103OtherBCBS DC
MD652102900Medicaid
MDKS82GROtherBCBS OF MD
MDKS82GROtherBCBS POS
MD4421835OtherAETNA
MDS103OtherBCBS DC
MDSRRGAOtherRAIL ROAD MEDICARE