1821153172 NPI number — DR. JOHN R VROOM MD

Table of content: DR. JOHN R VROOM MD (NPI 1821153172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821153172 NPI number — DR. JOHN R VROOM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VROOM
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1821153172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Provider Second Line Business Mailing Address:
2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-816-6650
Provider Business Mailing Address Fax Number:
301-816-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6501LOISDALE COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22150-1885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-922-1283
Provider Business Practice Location Address Fax Number:
703-922-1041
Provider Enumeration Date:
12/27/2006

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: 2080P0201X , with the licence number:  D0020026 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0201X , with the licence number: 0101020960 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0201X , with the licence number: MD6449 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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