Basic Information
Provider Information | |||||||||
NPI: | 1629749643 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FINCH | ||||||||
FirstName: | STEPHEN | ||||||||
MiddleName: | MARK | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CHIEF EMS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 251 NAJOLES RD STE A | ||||||||
Address2: |   | ||||||||
City: | MILLERSVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 211082519 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4432742888 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 BALTIMORE ST | ||||||||
Address2: |   | ||||||||
City: | LA PLATA | ||||||||
State: | MD | ||||||||
PostalCode: | 206463580 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3016093403 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/21/2021 | ||||||||
LastUpdateDate: | 09/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/27/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146L00000X | 0146497 | MD | Y |   | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic |   |
ID Information
ID | Type | State | Issuer | Description | 406085700 | 05 | MD |   | MEDICAID | 386BCH | 01 | MD | MEDICARE | OTHER |