1275614240 NPI number — DR. DEREN ELAINE BADER CPM, DRPH

Table of content: YVONNE LOUISE MCCORMICK (NPI 1831712827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275614240 NPI number — DR. DEREN ELAINE BADER CPM, DRPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADER
Provider First Name:
DEREN
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CPM, DRPH
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:
1275614240
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:
5 GILDERSLEEVE WOOD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22903-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-975-2697
Provider Business Mailing Address Fax Number:
434-295-8326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 BLAND CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22901-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-989-5021
Provider Business Practice Location Address Fax Number:
434-295-8326
Provider Enumeration Date:
10/18/2006

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: 176B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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