1427180058 NPI number — NATALIA GERACHENKO MPT

Table of content: NATALIA GERACHENKO MPT (NPI 1427180058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427180058 NPI number — NATALIA GERACHENKO MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERACHENKO
Provider First Name:
NATALIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1427180058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17B FIRSTFIELD RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-990-1449
Provider Business Mailing Address Fax Number:
301-990-1016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17B FIRSTFIELD RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-1785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-990-1449
Provider Business Practice Location Address Fax Number:
301-990-1016
Provider Enumeration Date:
03/09/2007

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: 225100000X , with the licence number:  18893 , 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: 480182 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 480182 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 01-0795823 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110A . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 010795823 . This is a "UNICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 126052700 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 480182 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J1080001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 01-0795823 . This is a "GREATWEST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 010795823 . This is a "PHCS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 010795823 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 405806200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-0795823 . This is a "GUARDIAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3312816 . This is a "AETNA HMO, POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7097210 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 010795823 . This is a "NCPPO PLAN 499247" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 480182 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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