{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "DORSAM & GENERIE, OD, LLC",
"LastName": null,
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"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5725 RICHARDS VALLEY RD STE A9",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELLICOTT CITY",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21043-6964",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-420-8113",
"MailingAddressFaxNumber": "443-420-8113",
"FirstLinePracticeLocationAddress": "6230 OLD DOBBIN LN STE 190",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21045-5954",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-420-8113",
"PracticeLocationAddressFaxNumber": "443-973-6998",
"EnumerationDate": "09/16/2013",
"LastUpdateDate": "04/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GENERIE",
"AuthorizedOfficialFirstName": "CHRISTINA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "443-420-8113",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152WC0802X",
"TaxonomyName": "Corneal and Contact Management Optometrist",
"LicenseNumber": "TA1997",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}