1902343486 NPI number — DEBORAH MITCHELL PARKER COTA/L

Table of content: DEBORAH MITCHELL PARKER COTA/L (NPI 1902343486)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902343486 NPI number — DEBORAH MITCHELL PARKER COTA/L

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
PARKER

Provider First Name:
DEBORAH

Provider Middle Name:
MITCHELL

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
COTA/L

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
MITCHELL

Provider Other First Name:
DEBORAH

Provider Other Middle Name:
LYNN

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902343486

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
01/27/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4220 4TH ST NW

Provider Second Line Business Mailing Address:
WASHINGTON

Provider Business Mailing Address City Name:
WASHINGTON

Provider Business Mailing Address State Name:
DC

Provider Business Mailing Address Postal Code:
20011-4844

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
202-487-3332

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7520 SURRATTS RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
CLINTON

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20735-3353

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
301-856-1660

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
01/23/2017

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: 224Z00000X , with the licence number: A02446 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .