1518136035 NPI number — EAR,NOSE & THROAT MEDICAL GROUP OF WASHINGTON P.C.

Table of content: (NPI 1518136035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518136035 NPI number — EAR,NOSE & THROAT MEDICAL GROUP OF WASHINGTON P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR,NOSE & THROAT MEDICAL GROUP OF WASHINGTON P.C.
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:
1518136035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 K ST NW
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20006-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-223-3560
Provider Business Mailing Address Fax Number:
202-223-3339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 K ST NW
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-223-3560
Provider Business Practice Location Address Fax Number:
202-223-3339
Provider Enumeration Date:
02/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VAP
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
GORDON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
202-223-3560

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  MD3439 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3700 . This is a "CAREFIRST BLUECROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 001037 . This is a "ANTHEM BLUECROSS BLUESHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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