1346567955 NPI number — MRS. DEBRA ANN INDORATO RD CLT

Table of content: MRS. DEBRA ANN INDORATO RD CLT (NPI 1346567955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346567955 NPI number — MRS. DEBRA ANN INDORATO RD CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INDORATO
Provider First Name:
DEBRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD CLT
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:
1346567955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 VANDERBILT AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-343-8873
Provider Business Mailing Address Fax Number:
757-961-7612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 VANDERBILT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23451-3667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-343-8873
Provider Business Practice Location Address Fax Number:
757-961-7612
Provider Enumeration Date:
04/23/2010

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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