1760661045 NPI number — LINDA JOHNSON DICKSON LINDA DICKSON MS

Table of content: LINDA JOHNSON DICKSON LINDA DICKSON MS (NPI 1760661045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760661045 NPI number — LINDA JOHNSON DICKSON LINDA DICKSON MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKSON
Provider First Name:
LINDA
Provider Middle Name:
JOHNSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LINDA DICKSON MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DICKSON
Provider Other First Name:
LINDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LINDA JOHNSON
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760661045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 HESKETH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEVY CHASE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20815-4225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-951-6186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5217 WISCONSIN AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20015-2075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-244-4995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2007

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: 1041C0700X , with the licence number:  LC50077743 , 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)





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