1013020718 NPI number — JANE M. LINGELBACH MD

Table of content: JANE M. LINGELBACH MD (NPI 1013020718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013020718 NPI number — JANE M. LINGELBACH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINGELBACH
Provider First Name:
JANE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013020718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5811 EDSON LN
Provider Second Line Business Mailing Address:
# 101
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-396-4871
Provider Business Mailing Address Fax Number:
301-270-7249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7610 CARROLL AVE STE 380
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAKOMA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20912-6323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-396-4871
Provider Business Practice Location Address Fax Number:
301-270-7249
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  D0056923 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4034961 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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