1285636522 NPI number — MEDSTAR GEORGETOWN MEDICAL CENTER, INC

Table of content: DR. SHANNON MARIE FARRELL PHARMD (NPI 1316598022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285636522 NPI number — MEDSTAR GEORGETOWN MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSTAR GEORGETOWN MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285636522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 418283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-8283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 RESERVOIR RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20007-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-896-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNEIDER
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
703-558-1403

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W675 . This is a "BLUE SHIELD PEDS PCP GRP#" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: W677 . This is a "BLUE SHIELD ADULT PCP GRP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 027174100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6572 . This is a "BLUE SHIELD GROUP NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 442AGE . This is a "BLUE SHIELD PEDS PCP GRP#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 097005100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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