Healthcare Provider Details

I. General information

NPI: 1306911995
Provider Name (Legal Business Name): ANNAPOLIS ASTHMA PULMONARY AND SLEEP SPEC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY SUITE 607
ANNAPOLIS MD
21401-3742
US

IV. Provider business mailing address

2000 MEDICAL PKWY SUITE 607
ANNAPOLIS MD
21401-3742
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-1644
  • Fax: 410-266-1642
Mailing address:
  • Phone: 410-266-1644
  • Fax: 410-266-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT T PETERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 410-266-1644