Basic Information
| Provider Information | |||||||||
| NPI: | 1275732265 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDITECH | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 708 WILLIAM ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212303965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436779229 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7120 MINSTREL WAY | ||||||||
| Address2: | SUITE #106 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210455248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102909191 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | BARTZ | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4436779229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | W11727070 | MD | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.