Provider Demographics
NPI:1730374448
Name:ASTHMA SINUS ALLERGY PROGRAM, LLC.
Entity type:Organization
Organization Name:ASTHMA SINUS ALLERGY PROGRAM, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-583-8393
Mailing Address - Street 1:6535 N CHARLES STREET
Mailing Address - Street 2:PPN 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-583-8393
Mailing Address - Fax:410-583-8394
Practice Address - Street 1:6535 N CHARLES STREET
Practice Address - Street 2:PPN 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-583-8393
Practice Address - Fax:410-583-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD112P310GMedicare PIN