1962568402 NPI number — THERESA MICHELE KOESTER PA

Table of content: THERESA MICHELE KOESTER PA (NPI 1962568402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962568402 NPI number — THERESA MICHELE KOESTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOESTER
Provider First Name:
THERESA
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1962568402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 WYMAN PARK DR
Provider Second Line Business Mailing Address:
JHCP BUSINESS OFFICE
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21211-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-338-3500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 NEW MEXICO AVE NW, SUITE 206
Provider Second Line Business Practice Location Address:
JHCP SURGERY FOXHALL
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-3622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-895-1440
Provider Business Practice Location Address Fax Number:
202-895-1448
Provider Enumeration Date:
12/29/2006

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: 363AS0400X , with the licence number:  PA030436 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 405951 . This is a "MEDICARE GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521467441 . This is a "JHCP TAX ID" identifier . This identifiers is of the category "OTHER".




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