1265977375 NPI number — LAUREN MCMILLON ATC, LAT, CES, ITAT

Table of content: (NPI 1497232128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265977375 NPI number — LAUREN MCMILLON ATC, LAT, CES, ITAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMILLON
Provider First Name:
LAUREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC, LAT, CES, ITAT
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:
1265977375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 GOVERNOR RITCHIE HWY
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-261-2243
Provider Business Mailing Address Fax Number:
410-384-1613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 GOVERNOR RITCHIE HWY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-261-2243
Provider Business Practice Location Address Fax Number:
410-384-1613
Provider Enumeration Date:
12/28/2016

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: 2255A2300X , with the licence number:  A00047 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X , with the licence number: J3-0000415 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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