1376611665 NPI number — INTEGRATED SURGICAL ASSOCIATES, PLLC

Table of content: (NPI 1376611665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376611665 NPI number — INTEGRATED SURGICAL ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED SURGICAL ASSOCIATES, PLLC
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:
1376611665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13437 CRANDALL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23233-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-360-1855
Provider Business Mailing Address Fax Number:
804-360-1629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8241 GEORGIA AVE
Provider Second Line Business Practice Location Address:
SUITE #102
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-589-8737
Provider Business Practice Location Address Fax Number:
240-450-5700
Provider Enumeration Date:
12/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
804-360-1855

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0061148 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001014600 . This is a "MARYLAND MEDICAL ASSISTANCE (MAO)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 105656 . This is a "ATHTHEM BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 238514 . This is a "BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3640878 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 826A . This is a "CAREFIRST CAPITAL CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 21849 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5396573 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 105657 . This is a "ANTHEM BC BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 458642 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 001014600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036747600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 238513 . This is a "ANTHEM BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 718333 . This is a "NCPPO UNICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1014600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5798960 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J740-001 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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