1831645639 NPI number — WASHINGTON COUNTY HEALTH DEPARTMENT-CENTRAL35

Table of content: DINAH MAULAWIN VITUG DDS (NPI 1235597303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831645639 NPI number — WASHINGTON COUNTY HEALTH DEPARTMENT-CENTRAL35

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON COUNTY HEALTH DEPARTMENT-CENTRAL35
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:
1831645639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 PENNYSLVANIA AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-313-3492
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 N BURHANS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21742-3173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-313-3310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
STONER
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
240-313-3436

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S285 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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