1528122835 NPI number — ERIN BURLOVICH MCDONALD PT, DPT, OCS

Table of content: ERIN BURLOVICH MCDONALD PT, DPT, OCS (NPI 1528122835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528122835 NPI number — ERIN BURLOVICH MCDONALD PT, DPT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
ERIN
Provider Middle Name:
BURLOVICH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURLOVICH
Provider Other First Name:
ERIN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, OCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528122835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-687-8181
Provider Business Mailing Address Fax Number:
540-687-8256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13890 BRADDOCK RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20121-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-830-6360
Provider Business Practice Location Address Fax Number:
703-830-6362
Provider Enumeration Date:
12/21/2006

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: 225100000X , with the licence number:  21489 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 2305204299 , 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)





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