1477885341 NPI number — THE MEDICAL CLINIC

Table of content: (NPI 1477885341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477885341 NPI number — THE MEDICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEDICAL CLINIC
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:
1477885341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12200 ANNAPOLIS RD
Provider Second Line Business Mailing Address:
STE 225
Provider Business Mailing Address City Name:
GLENN DALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20769-9182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-860-0930
Provider Business Mailing Address Fax Number:
301-809-0929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4217 EVERGREEN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-886-8363
Provider Business Practice Location Address Fax Number:
301-441-8806
Provider Enumeration Date:
02/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LAKHANPAL
Authorized Official First Name:
SANJIV
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
240-460-1073

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0053733 , 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: G00397 . This is a "MEDICARE ID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 893L . This is a "MEDICARE ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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