1033305263 NPI number — FREDERICK KIDNEY CARE ASSOCIATES LLC.

Table of content: PETER JOSEPH VAN TWUYVER PT (NPI 1871534495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033305263 NPI number — FREDERICK KIDNEY CARE ASSOCIATES LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK KIDNEY CARE ASSOCIATES LLC.
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:
1033305263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5205 CHAIRMANS CT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21703-2915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-696-0012
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5205 CHAIRMANS CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-696-0012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RENGEN
Authorized Official First Name:
ROHAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
301-696-0012

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  W12133963 , 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)





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