1164058376 NPI number — MR. TRAVIS ARTHUR MCCORMACK MA ATC

Table of content: MR. TRAVIS ARTHUR MCCORMACK MA ATC (NPI 1164058376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164058376 NPI number — MR. TRAVIS ARTHUR MCCORMACK MA ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCORMACK
Provider First Name:
TRAVIS
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA ATC
Provider Gender Code:
M

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:
1164058376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18815 CROSS COUNTRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20879-4612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-797-2530
Provider Business Mailing Address Fax Number:
202-687-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GEORGETOWN UNIVERSITY 37TH AND O ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20057-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-687-2362
Provider Business Practice Location Address Fax Number:
202-687-4117
Provider Enumeration Date:
03/19/2020

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: 2255A2300X ; 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