Provider Demographics
NPI:1679766950
Name:MARYLAND LUNG ASSOCIATES PA
Entity type:Organization
Organization Name:MARYLAND LUNG ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-644-5112
Mailing Address - Street 1:3449 WILKENS AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BALITIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229
Mailing Address - Country:US
Mailing Address - Phone:410-644-5112
Mailing Address - Fax:410-644-6517
Practice Address - Street 1:3449 WILKENS AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:BALITIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-644-5112
Practice Address - Fax:410-644-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42116302OtherBLUE SHIELD
CA1235OtherRRMC GROUP
MDKS48MAOtherBLUE SHIELD
MD42116301OtherBLUE SHIELD
CA1235OtherRRMC GROUP