1235384900 NPI number — IVAN L ROBINSON AND ASSOCIATES

Table of content: (NPI 1235384900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235384900 NPI number — IVAN L ROBINSON AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IVAN L ROBINSON AND ASSOCIATES
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:
1235384900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 MICHIGAN AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20017-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-652-0536
Provider Business Mailing Address Fax Number:
202-536-4369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 MICHIGAN AVE NE
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:
20017-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-652-0536
Provider Business Practice Location Address Fax Number:
202-536-4369
Provider Enumeration Date:
11/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
IVAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PROVIDOR
Authorized Official Telephone Number:
202-652-0536

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1010528 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 038623500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".