DR. MARILYN D SHORT MD, NPI 1710081971 — BALTIMORE (MD)

NPI 1710081971

13+ Years Experience Individual

DR. MARILYN D SHORT MD

09.11.2006
PROVIDER ENUMERATION DATE
05.09.2013
LAST UPDATE DATE
1710081971
NPI NUMBER

About DR. MARILYN D SHORT

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

DR. MARILYN D SHORT is a provider established in BALTIMORE, MD. The NPI number of DR. MARILYN D SHORT is 1710081971 and was assigned on 09.11.2006. The practitioners primary taxonomy code is: 207V00000X with license number: D30432 MD .

Mailing address

  • City: BALTIMORE
  • State: MD
  • Postal code: 21211
  • Address: 3100 WYMAN PARK DRIVE
  • Address 2: SUITE 359A

Primary Practice Address

  • Region : BALTIMORE, MD
  • NPI : 1710081971
  • Phone : 4103383016
  • Fax : 4103383420
  • Postalcode : 21211
  • Address : 3100 WYMAN PARK DRIVE SUITE 359A

Additional identifiers

  • Identifier: 372951600
  • Code / Type : 5 - MEDICAID
  • Identifier state : MD

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Obstetrics & Gynecology

  • Taxonomy code: 207V00000X
  • License number: D30432
  • License state: MD

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

Contacts:

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  • DR. MARILYN D SHORT MD
  • Address : 3100 WYMAN PARK DRIVE SUITE 359A
  • Region : BALTIMORE, MD
  • NPI : 1710081971
  • Phone : 4103383016
  • Fax : 4103383420
  • Postalcode : 21211

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address3100 WYMAN PARK DRIVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 359A
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBALTIMORE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code21211
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number4103383016
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4103383420
The fax number associated with the location address of the provider being identified.
NPI1710081971
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1207V00000X
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
Provider Enumeration Date09.11.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated05.09.2013
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. MARILYN D SHORT
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address3100 WYMAN PARK DRIVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 359A
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameBALTIMORE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code21211
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Healthcare Provider Taxonomy Code #1207V00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
Provider License Number 1D30432
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MD
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1372951600
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1MD
Other Provider Identifier State #1
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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