NPIMap

Organization Active NPI

Immutech-Midatlantic, LLC

  • Family Nurse Practitioner
  • Windsor Mill, MD
National Provider Identifier
1740874627
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
IMMUTECH-MIDATLANTIC, LLC
Practice address
1940 Winder Rd
Windsor Mill, MD 21244-1729
Phone
(410) 215-2596
NPI assigned
Feb 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Authorized official

Name
Robin BucknerNPI 1588256796
Title
Ceo
Phone
(410) 215-2596

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1940 Winder Rd
Windsor Mill, MD 21244-1729

Mailing address

1940 Winder Rd
Windsor Mill, MD 21244-1729
Phone (410) 215-2596

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1740874627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 WINDER RD",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212441729",
            "telephone_number": "410-215-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 WINDER RD",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212441729",
            "telephone_number": "410-215-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMUTECH-MIDATLANTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "BUCKNER",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-215-2596"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor Mill, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.