=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760694624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUNG ASSOCIATES OF ANNE ARUNDEL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 11/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 HOSPITAL DR SUITE 305 TATE CENTER
-----------------------------------------------------
City | GLEN BURNIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21061-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-768-3701
-----------------------------------------------------
Fax | 410-766-0881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 HOSPITAL DR SUITE 305 TATE CENTER
-----------------------------------------------------
City | GLEN BURNIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21061-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-768-3701
-----------------------------------------------------
Fax | 410-766-0881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATION
-----------------------------------------------------
Name | JULIE STENCIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-553-8254
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------