Basic Information
| Provider Information | |||||||||
| NPI: | 1578829354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANNAPOLIS ALLERGY & ASTHMA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7801 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049157800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105731600 | ||||||||
| FaxNumber: | 4105735841 | ||||||||
| Practice Location | |||||||||
| Address1: | 4175 N HANSON CT | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105731600 | ||||||||
| FaxNumber: | 4105735841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2012 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | GELS | ||||||||
| AuthorizedOfficialFirstName: | DUANE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN AND OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4105731600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | D40281 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.