=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578870259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELIA S. CHITIMUS D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2010
-----------------------------------------------------
Last Update Date | 09/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 NURSERY RD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-848-5577
-----------------------------------------------------
Fax | 410-876-3760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10420 SWIFT STREAM PL APT 106
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-4584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-631-4765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 14394
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------