1134196314 NPI number — MISS BRANDI ALYSSA RITTER P.A.

Table of content: MISS BRANDI ALYSSA RITTER P.A. (NPI 1134196314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134196314 NPI number — MISS BRANDI ALYSSA RITTER P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RITTER
Provider First Name:
BRANDI
Provider Middle Name:
ALYSSA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1134196314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 VISTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21740-4151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-393-0808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MALCOLM GROW MEDICAL CENTER
Provider Second Line Business Practice Location Address:
1050 WEST PERIMETER ROAD
Provider Business Practice Location Address City Name:
ANDREWS AFB
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20762-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-857-4530
Provider Business Practice Location Address Fax Number:
240-857-8952
Provider Enumeration Date:
03/07/2006

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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