1235102161 NPI number — DANIEL JONATHAN MECKEL PHD LGSW

Table of content: DANIEL JONATHAN MECKEL PHD LGSW (NPI 1235102161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235102161 NPI number — DANIEL JONATHAN MECKEL PHD LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MECKEL
Provider First Name:
DANIEL
Provider Middle Name:
JONATHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD LGSW
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:
1235102161
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:
PO BOX 826
Provider Second Line Business Mailing Address:
TRICO CORPORATION
Provider Business Mailing Address City Name:
LEXINGTON PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20653-0826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-862-4966
Provider Business Mailing Address Fax Number:
301-862-5554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 INDUSTRIAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20602-2792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-632-2100
Provider Business Practice Location Address Fax Number:
301-632-2150
Provider Enumeration Date:
02/10/2006

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: 101YM0800X , with the licence number:  G11938 , 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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