1114168192 NPI number — LUXXERY CORPORATION OF MARYLAND

Table of content: (NPI 1114168192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114168192 NPI number — LUXXERY CORPORATION OF MARYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUXXERY CORPORATION OF MARYLAND
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUXXERY
Provider Other Organization Name Type Code:
4
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:
1114168192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 CRAIN HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-843-9769
Provider Business Mailing Address Fax Number:
301-843-8941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 CRAIN HWY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20601-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-843-9769
Provider Business Practice Location Address Fax Number:
301-843-8941
Provider Enumeration Date:
03/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HAKKI
Authorized Official First Name:
AYMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-843-9769

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  D0035306 , 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)





Copyright © 2007-2024 www.npivalidator.com