1841222973 NPI number — ROBERTA WORRALL-FELDHAUSEN APRN

Table of content: (NPI 1366426223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841222973 NPI number — ROBERTA WORRALL-FELDHAUSEN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORRALL-FELDHAUSEN
Provider First Name:
ROBERTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

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:
1841222973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 EXECUTIVE DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-402-2379
Provider Business Mailing Address Fax Number:
410-469-3085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 GRACEFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20904-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-572-8340
Provider Business Practice Location Address Fax Number:
301-572-8403
Provider Enumeration Date:
07/07/2006

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: 364SP0808X , with the licence number:  R119532 , 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: 0943SE-643880-01 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8302101 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0041 . This is a "CAREFRIST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0943ER-643880-01 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64388001 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9680-0019 . This is a "CAREFIRST BCBS OF DC" identifier . This identifiers is of the category "OTHER".




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