1821328212 NPI number — MRS. KIMBERLY DENISE HANSON DPT

Table of content: KATHERINE D WESTFALL (NPI 1346848835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821328212 NPI number — MRS. KIMBERLY DENISE HANSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
KIMBERLY
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORRO
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
HANSON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821328212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20410 CENTURY BLVD
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20874-1186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-540-6140
Provider Business Mailing Address Fax Number:
301-540-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9501 OLD ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
DORSEY HALL MEDICAL CENTER, SUITE 125
Provider Business Practice Location Address City Name:
ELLICOTT CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21042-6314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-997-1063
Provider Business Practice Location Address Fax Number:
410-997-1408
Provider Enumeration Date:
01/06/2010

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: 225100000X , with the licence number:  22921 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 182132821 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 182132821 . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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