1235525700 NPI number — DR. DEREK NATHANIEL MUSGROVE MBBS

Table of content: DR. DEREK NATHANIEL MUSGROVE MBBS (NPI 1235525700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235525700 NPI number — DR. DEREK NATHANIEL MUSGROVE MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSGROVE
Provider First Name:
DEREK
Provider Middle Name:
NATHANIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
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:
1235525700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2041 GEORGIA AVE NW
Provider Second Line Business Mailing Address:
HOWARD UNIVERISTY HOSPITAL
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20060-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-855-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 QUEEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SASKATOON
Provider Business Practice Location Address State Name:
SASKATCHEWAN
Provider Business Practice Location Address Postal Code:
S7K 0M7
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
306-222-5974
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2015

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: 207ZF0201X , with the licence number:  12242 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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