Ellicott City Primary Care Medicine PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D0028246 Issued in MD

Legal business name

ELLICOTT CITY PRIMARY CARE MEDICINE PA

Practice address

10298B Baltimore National Pike
Ellicott City, MD 21042-3670

Phone

(410) 465-1091

Fax

(410) 465-8129

NPI assigned

Dec 2, 2007

Last updated

Sep 17, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles Edward Sheehan III, M.D.

Title

President

Phone

(410) 465-1090

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1033391081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10298B BALTIMORE NATIONAL PIKE",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423670",
            "telephone_number": "410-465-1091",
            "fax_number": "410-465-8129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10298B BALTIMORE NATIONAL PIKE",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423670",
            "telephone_number": "410-465-1091",
            "fax_number": "410-465-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLICOTT CITY PRIMARY CARE MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-02",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "SHEEHAN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-465-1090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0028246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1033391081",
            "identifier": "ORGANIZATIONAL NPI",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellicott City Pediatric Assoc
• Ellicott City Pediatric Associates, PA
• Ellicott City Pharmacy Inc (Ellicott City Pharmacy LTC)
• Ellicott City Pharmacy Inc (Ellicott City Pharmacy)
• Ellicott City Primary Care LLC
• Ellicott City Total Eye Care LLC
• Ellicott City Wellness Chiropractic, L.L.C.
• Ellicott City Womens Health
• Ellicott Dental & Specialty LLC (BluePointe Dental (Ellicott))
• Ellicott Kidney Center LLC

• Internal Medicine Physician in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.