1750371118 NPI number — HUGH LEE PREAS II MD

Table of content: HUGH LEE PREAS II MD (NPI 1750371118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750371118 NPI number — HUGH LEE PREAS II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PREAS
Provider First Name:
HUGH
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
MD
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:
1750371118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 790058
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63179-0058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-549-2380
Provider Business Mailing Address Fax Number:
314-569-5974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5530 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
SUITE 1620
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-718-9800
Provider Business Practice Location Address Fax Number:
301-986-1672
Provider Enumeration Date:
10/26/2005

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: 207L00000X , with the licence number:  D0043021 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: D0043021 , 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)

  • Identifier: 5263677 . This is a "CCN FH" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".
  • Identifier: 0001 GRP S417 . This is a "CAREFIRST BC BS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 086451000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050087029 . This is a "RR MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1619157 . This is a "FIRST HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5608478 . This is a "AETNA US HEALTH CARE PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2961252 . This is a "AETNA US HEALTH CARE HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KBC1CH . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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