1518091453 NPI number — DEAN J STORER MD PC

Table of content: BENNIE JOE KUHLMANN DC (NPI 1366063190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518091453 NPI number — DEAN J STORER MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEAN J STORER MD PC
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:
1518091453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44050-195 ASHBURN PLAZA
Provider Second Line Business Mailing Address:
BOX 710
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-723-1980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 STEVENSON AVE STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-379-7215
Provider Business Practice Location Address Fax Number:
202-265-7804
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STORER
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-379-7215

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X , with the licence number:  0101-045175 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B571 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 007709889 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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