Basic Information
| Provider Information | |||||||||
| NPI: | 1043202591 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | Y | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YOUNG | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 11055 LITTLE PATUXENT PKWY | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107402900 | ||||||||
| FaxNumber: | 4107402955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0050778 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1454492 | 01 | MD | CIGNA PIN | OTHER | 5164715 | 01 | MD | AETNA FEE FOR SERVICE | OTHER | P13465 | 01 | MD | CAREFIRST MPOS | OTHER | 2106808 | 01 | MD | AETNA CAPITATED | OTHER | 759950100 | 05 | MD | MEDICAID | 267853 | 01 | MD | MAMSI SPECIALIST | OTHER | 3509-0011 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 021983 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 546577-02 | 01 | MD | CAREFIRST MD RENDERING | OTHER | 80117369 | 01 | MD | RR MEDICARE | OTHER | 867853 | 01 | MD | MAMSI PRIMARY CARE | OTHER |