1548350929 NPI number — MRS. COLLEEN VIRGINIA GROVES R.D., L.D., C.D.E.

Table of content: MRS. COLLEEN VIRGINIA GROVES R.D., L.D., C.D.E. (NPI 1548350929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548350929 NPI number — MRS. COLLEEN VIRGINIA GROVES R.D., L.D., C.D.E.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROVES
Provider First Name:
COLLEEN
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D., L.D., C.D.E.
Provider Gender Code:
F

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:
1548350929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1027 MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21550-4343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-533-3300
Provider Business Mailing Address Fax Number:
301-533-3299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1027 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21550-4343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-533-3300
Provider Business Practice Location Address Fax Number:
301-533-3299
Provider Enumeration Date:
10/13/2006

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: 133V00000X , 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)





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