1063858066 NPI number — MR. CARLETO AGUSTUS LINTON LCADC

Table of content: MR. CARLETO AGUSTUS LINTON LCADC (NPI 1063858066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063858066 NPI number — MR. CARLETO AGUSTUS LINTON LCADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINTON
Provider First Name:
CARLETO
Provider Middle Name:
AGUSTUS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCADC
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:
1063858066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
266 LUGUAIN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-379-7055
Provider Business Mailing Address Fax Number:
443-660-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 WARREN RD
Provider Second Line Business Practice Location Address:
SUITE 12-B
Provider Business Practice Location Address City Name:
PIKESVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-5334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-379-7055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2013

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com