1770980757 NPI number — PHYSIATRY-SPORTS & FAMILY MEDICINE, LLC

Table of content: BARBARA A. DIPAOLO R.PH. (NPI 1285911297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770980757 NPI number — PHYSIATRY-SPORTS & FAMILY MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIATRY-SPORTS & FAMILY MEDICINE, 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:
1770980757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15763
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23328-5763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-366-0200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2147 OLD GREENBRIER RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-366-0200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-366-0200

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  0101241301 , 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)





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