Mattie'S Bra Shop

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MATTIE'S BRA SHOP

Practice address

8457 Baltimore National Pike
Suite 17
Ellicott City, MD 21043-4209

Phone

(410) 750-7950

Fax

(410) 730-8402

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mattie M. Stanford

Title

Owner

Phone

(410) 730-8402

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1497866610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5514 HARVEST SCENE CT",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442705",
            "telephone_number": "410-730-8402",
            "fax_number": "410-730-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8457 BALTIMORE NATIONAL PIKE",
            "address_2": "SUITE 17",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434209",
            "telephone_number": "410-750-7950",
            "fax_number": "410-730-8402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTIE'S BRA SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "STANFORD",
        "authorized_official_first_name": "MATTIE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-730-8402",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "361103505",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lamberto Masibac
• Alfred J Maskeroni, DDS
• Lisa Marie Massie, DPT
• Isabella K Mate
• Davis Mathew, MD
• Nicole C Maus-Chaudhury, LCSW-C
• Maxine V. Clark, D.D.S., P.a.
• Justin Maxwell, DDS
• Christina L Mazzi, LCPC
• Henriette Doris Mbiakop Famawa

• Prosthetic/Orthotic Supplier in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Prosthetic/Orthotic Supplier in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.