1275602591 NPI number — CHARTERED FAMILY HELATH CENTER

Table of content: (NPI 1275602591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275602591 NPI number — CHARTERED FAMILY HELATH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARTERED FAMILY HELATH CENTER
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:
1275602591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14815 CROSS RIVER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURTONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20866-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-698-7342
Provider Business Mailing Address Fax Number:
202-698-7028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3924 MINNESOTA 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:
20019-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-398-8683
Provider Business Practice Location Address Fax Number:
202-627-7806
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEYNE
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
HEGAR
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
202-398-8683

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  363L00000X , 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)





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