1265435523 NPI number — EVELINE B MARQUARDT M.D.

Table of content: EVELINE B MARQUARDT M.D. (NPI 1265435523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265435523 NPI number — EVELINE B MARQUARDT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARQUARDT
Provider First Name:
EVELINE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1265435523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 TOWN CENTER DR
Provider Second Line Business Mailing Address:
STE 319
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20190-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-668-0520
Provider Business Mailing Address Fax Number:
703-668-0525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 TOWN CENTER DR
Provider Second Line Business Practice Location Address:
STE 319
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-668-0520
Provider Business Practice Location Address Fax Number:
703-668-0525
Provider Enumeration Date:
05/31/2005

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: 207V00000X , with the licence number:  0101043271 , 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: F910 . This is a "CAREFIRST PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4315160 . This is a "AETNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 503858 . This is a "NCPPO PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 259706 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com