1730308511 NPI number — CYRIL JOSEPH MD PC

Table of content: DR. MITCHELL ARLEN LOMKE D.D.S. (NPI 1063430676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730308511 NPI number — CYRIL JOSEPH MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYRIL JOSEPH 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:
1730308511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20925 PROFESSIONAL PLZ
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-3403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20925 PROFESSIONAL PLZ
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-724-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
CYRIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-577-8745

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101223436 , 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)