1174695647 NPI number — DR. ANITA V PILLAI-ALLEN M.D.

Table of content: DR. ANITA V PILLAI-ALLEN M.D. (NPI 1174695647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174695647 NPI number — DR. ANITA V PILLAI-ALLEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PILLAI-ALLEN
Provider First Name:
ANITA
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1174695647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8110 MAPLE LAWN BLVD STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-2693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-340-8339
Provider Business Mailing Address Fax Number:
301-340-9027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10301 GEORGIA AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-592-1600
Provider Business Practice Location Address Fax Number:
301-592-1602
Provider Enumeration Date:
11/14/2006

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: 207VF0040X , with the licence number:  D0068350 , 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: 416130100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: D0068350 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com