1730383498 NPI number — DR. ETWAR H MCBEAN M.D.

Table of content: DR. ETWAR H MCBEAN M.D. (NPI 1730383498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730383498 NPI number — DR. ETWAR H MCBEAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCBEAN
Provider First Name:
ETWAR
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1730383498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 GREENWAY CENTER DR STE 1120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-3563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-206-8506
Provider Business Mailing Address Fax Number:
240-929-6978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 GREENWAY CENTER DR STE 1120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-3563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-206-8506
Provider Business Practice Location Address Fax Number:
240-929-6978
Provider Enumeration Date:
06/14/2007

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: 208600000X , with the licence number:  MD035602 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD433352 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: ME98540 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: D0073377 , 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)

  • Identifier: MD035602 . This is a "HEALTH PROFESSIONAL LICENSING ADMINISTRATION" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: ME98540 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: MD433352 . This is a "DEPARTMENT OF STATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".