1740519826 NPI number — THE NEUROLOGICAL MEDICINE SLEEP LABORATORY

Table of content: (NPI 1740519826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740519826 NPI number — THE NEUROLOGICAL MEDICINE SLEEP LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NEUROLOGICAL MEDICINE SLEEP LABORATORY
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:
1740519826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 HANOVER PKWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-982-7944
Provider Business Mailing Address Fax Number:
301-441-8696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13938 BALTIMORE AVE
Provider Second Line Business Practice Location Address:
BLDG 3 B
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-982-7944
Provider Business Practice Location Address Fax Number:
301-441-8696
Provider Enumeration Date:
12/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEAHY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-982-7944

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1654 . This is a "CAREFIRST BCBS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 912931600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: H832NE . This is a "CAREFIRST BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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