1144269002 NPI number — LIDEE OF AESTHETICS AND GYNECOLOGY, PC

Table of content: (NPI 1144269002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144269002 NPI number — LIDEE OF AESTHETICS AND GYNECOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIDEE OF AESTHETICS AND GYNECOLOGY, PC
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:
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:
1144269002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1992 MEDICAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISONBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22801-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-437-1296
Provider Business Mailing Address Fax Number:
540-437-1298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1992 MEDICAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISONBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22801-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-437-1296
Provider Business Practice Location Address Fax Number:
540-437-1298
Provider Enumeration Date:
06/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRAITHWAITE
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
540-437-1296

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  101054345 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 101037944 , 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)

  • Identifier: 541480016005 . This is a "DR CAMPER CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1477716959 . This is a "DR MARLO NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00341994 . This is a "RAILROAD MEDICARE PTAN-DR CAMPER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1477716959 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: DF1466 . This is a "RAILROAD MEDICAL PTAN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2129961 . This is a "DR CAMPER MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 144250 . This is a "DR CAMPER ANTHEM PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 243253 . This is a "DR CAMPER SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".