Basic Information
| Provider Information | |||||||||
| NPI: | 1649426081 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR CAMPUS PRIMARY CARE PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 RESEARCH PARK DR | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212284664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104022258 | ||||||||
| FaxNumber: | 4102047279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CEDAR CREST VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | POMPTON PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074442100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738313540 | ||||||||
| FaxNumber: | 9738313503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | NARRETT | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC VP/CMO | ||||||||
| AuthorizedOfficialTelephone: | 4104022261 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 6145940003 | 01 | DME | OTHER |