1558483073 NPI number — DR. MONICA LEONIE MEERBAUM PH.D.

Table of content: DR. MONICA LEONIE MEERBAUM PH.D. (NPI 1558483073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558483073 NPI number — DR. MONICA LEONIE MEERBAUM PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEERBAUM
Provider First Name:
MONICA
Provider Middle Name:
LEONIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEERBAUM
Provider Other First Name:
MONICA
Provider Other Middle Name:
LEONIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558483073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4915 SAINT ELMO AVE
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-6019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-587-6211
Provider Business Mailing Address Fax Number:
301-986-0104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4915 SAINT ELMO AVE
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-6019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-587-6211
Provider Business Practice Location Address Fax Number:
301-986-0104
Provider Enumeration Date:
04/04/2007

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: 103TC0700X , with the licence number:  01518 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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