1679621809 NPI number — MR. FRANK S. ABATE V

Table of content: MR. FRANK S. ABATE V (NPI 1679621809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679621809 NPI number — MR. FRANK S. ABATE V

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABATE
Provider First Name:
FRANK
Provider Middle Name:
S.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
V
Provider Credential Text:
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:
1679621809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4651 KELL LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22311-4917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-998-5292
Provider Business Mailing Address Fax Number:
703-998-5292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4651 KELL LANE
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:
22311-4917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-998-5292
Provider Business Practice Location Address Fax Number:
703-998-5292
Provider Enumeration Date:
01/05/2007

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: 101YM0800X , with the licence number:  LC0481 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: PRC1364 , 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: 100024765001 . This is a "APS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 220818 . This is a "MHN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 67450001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 7439105 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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