1750380887 NPI number — DR. HAZEL E BOWEN-WRIGHT MD

Table of content: DR. HAZEL E BOWEN-WRIGHT MD (NPI 1750380887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750380887 NPI number — DR. HAZEL E BOWEN-WRIGHT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN-WRIGHT
Provider First Name:
HAZEL
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1750380887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3022 JAVIER RD
Provider Second Line Business Mailing Address:
SUITES 105G
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-676-3433
Provider Business Mailing Address Fax Number:
703-676-3438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3022 JAVIER RD
Provider Second Line Business Practice Location Address:
SUITES 105G
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-676-3433
Provider Business Practice Location Address Fax Number:
703-676-3438
Provider Enumeration Date:
07/20/2005

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: 207RE0101X , with the licence number:  D0056768 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 0101235232 , 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)

  • Identifier: 64524904 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 407289800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64524905 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0003 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116536 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5388737 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64524903 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64524901 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64524902 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64524906 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3945866 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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