1083941603 NPI number — MISS DOMINIQUE TAMARA MCLAUGHLIN

Table of content: MISS DOMINIQUE TAMARA MCLAUGHLIN (NPI 1083941603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083941603 NPI number — MISS DOMINIQUE TAMARA MCLAUGHLIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLAUGHLIN
Provider First Name:
DOMINIQUE
Provider Middle Name:
TAMARA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCLAUGHLIN
Provider Other First Name:
DOMINIQUE
Provider Other Middle Name:
TAMARA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1083941603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23093-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-967-2880
Provider Business Mailing Address Fax Number:
540-967-0973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 OLD LYNCHBURG ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23093-0608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-967-2880
Provider Business Practice Location Address Fax Number:
540-967-0973
Provider Enumeration Date:
11/04/2009

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: 101YM0800X , with the licence number:  0701004687 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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