Basic Information
| Provider Information | |||||||||
| NPI: | 1467439752 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DRS MORRES GIANELLE GOERTZEN & ASSOC PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHESAPEAKE MEDICAL SOLUTIONS TA YOUR DOC'S IN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 CALLOWAY ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218043200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346351 | ||||||||
| FaxNumber: | 4103346352 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 120TH STREET | ||||||||
| Address2: | |||||||||
| City: | OCEAN CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105200582 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | GIANELLE | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4103346351 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20235706 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000038586 | 05 | DE | MEDICAID | DD9023 | 01 | MD | RAILROAD MEDICARE | OTHER | 11ZMYO | 01 | MD | BLUE CROSS BLUE SHIELD | OTHER | 3780 | 01 | DC | BLUE CROSS BLUE SHIELD | OTHER | 7603709 | 01 | MD | AETNA | OTHER | 408316400 | 05 | MD | MEDICAID | 2145659 | 01 | MD | ALLIANCE ONENET | OTHER |