1326169541 NPI number — DR. KEITA L VANTERPOOL D.C.

Table of content: DR. KEITA L VANTERPOOL D.C. (NPI 1326169541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326169541 NPI number — DR. KEITA L VANTERPOOL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANTERPOOL
Provider First Name:
KEITA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1326169541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20030-0276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-744-3430
Provider Business Mailing Address Fax Number:
202-536-2478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 GOOD HOPE RD SE APT 916
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:
20020-5132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-744-3430
Provider Business Practice Location Address Fax Number:
202-536-2478
Provider Enumeration Date:
04/03/2007

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: 111N00000X , with the licence number:  CH30018 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: SO3383 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: CH30018 , 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)