1104805985 NPI number — MRS. VIRGINIA MARIE STANDFORD MSPT

Table of content: MRS. VIRGINIA MARIE STANDFORD MSPT (NPI 1104805985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104805985 NPI number — MRS. VIRGINIA MARIE STANDFORD MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANDFORD
Provider First Name:
VIRGINIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1104805985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9007 GRAPE CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALKERSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21793-8808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-845-7289
Provider Business Mailing Address Fax Number:
240-215-9026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 SOLAREX CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703-8624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-215-9023
Provider Business Practice Location Address Fax Number:
240-215-9026
Provider Enumeration Date:
01/11/2006

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: 225100000X , with the licence number:  18657 , 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: K1340002 . This is a "CAP/FED BC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 602030700 . This is a "DEPT OF LABOR MSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R5590003 . This is a "FSS CAP BC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 147719000 . This is a "DEPT OF LABOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 546240-06 . This is a "CAREFIRST FSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 54624007 . This is a "MSS BC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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