1508971680 NPI number — BRIAN JOSEPH MONROE CPO

Table of content: MANSOOR BEG (NPI 1104183029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508971680 NPI number — BRIAN JOSEPH MONROE CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONROE
Provider First Name:
BRIAN
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPO
Provider Gender Code:
M

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:
1508971680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 24TH ST NW STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20037-2543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-338-0770
Provider Business Mailing Address Fax Number:
202-315-3176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 24TH ST NW STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-2543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-338-0770
Provider Business Practice Location Address Fax Number:
202-315-3176
Provider Enumeration Date:
08/20/2006

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: 224P00000X , with the licence number:  1705 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010232775 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1030109 . This is a "ACM" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 4417 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 409782300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 037399700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".