1366615304 NPI number — IEON L.O. DAWSON

Table of content: ANA KERSY BLANCHARD MASTERS (NPI 1821635640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366615304 NPI number — IEON L.O. DAWSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IEON L.O. DAWSON
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:
6
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:
1366615304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1257 GERSTNER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAMBRILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21054-1935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-669-5821
Provider Business Mailing Address Fax Number:
410-721-4488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 OLD BRANCH AVE
Provider Second Line Business Practice Location Address:
SUITE B205
Provider Business Practice Location Address City Name:
GAMBRILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21054-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-669-5821
Provider Business Practice Location Address Fax Number:
410-721-4488
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
CARLINE
Authorized Official Middle Name:
PAMELLA
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
202-669-5821

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 017174700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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