Basic Information
Provider Information | |||||||||
NPI: | 1710163332 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OH | ||||||||
FirstName: | ADRIANNE | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 220 HITCHENS AVE | ||||||||
Address2: | UNIT 101 | ||||||||
City: | OCEAN CITY | ||||||||
State: | MD | ||||||||
PostalCode: | 218427561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3364065823 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6040 PUBLIC LANDING RD | ||||||||
Address2: |   | ||||||||
City: | SNOW HILL | ||||||||
State: | MD | ||||||||
PostalCode: | 218632453 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106329915 | ||||||||
FaxNumber: | 4106329902 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/14/2008 | ||||||||
LastUpdateDate: | 06/16/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X |   | MD | N |   | Other Service Providers | Case Manager/Care Coordinator |   | 104100000X | 19183 | MD | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
ID Information
ID | Type | State | Issuer | Description | 705371101 | 05 | MD |   | MEDICAID |