1730359423 NPI number — SLEEP DISORDERS CTRS OF THE MID ATLANTIC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730359423 NPI number — SLEEP DISORDERS CTRS OF THE MID ATLANTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP DISORDERS CTRS OF THE MID ATLANTIC LLC
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:
1730359423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2235 CEDAR LN
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22182-5202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-752-7881
Provider Business Mailing Address Fax Number:
703-752-7880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15235 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-977-1662
Provider Business Practice Location Address Fax Number:
301-977-1669
Provider Enumeration Date:
03/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PERLSTROM
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-752-7881

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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