1891856373 NPI number — DR. LAWRENCE Y. C. AGODOA M.D.

Table of content: RIGOBERTO MARTINEZ (NPI 1285273607)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891856373 NPI number — DR. LAWRENCE Y. C. AGODOA M.D.

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
AGODOA

Provider First Name:
LAWRENCE

Provider Middle Name:
Y. C.

Provider Name Prefix Text:
DR.

Provider Name Suffix Text:

Provider Credential Text:
M.D.

Provider Gender Code:
M

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:
1891856373

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
04/04/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13217 GLENHILL RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
SILVER SPRING

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20904-3260

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
301-384-9386

Provider Business Mailing Address Fax Number:
301-594-9358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4650 TAYLOR RD

Provider Second Line Business Practice Location Address:
4650 TAYLOR ROAD BLDG 17A RM 3019

Provider Business Practice Location Address City Name:
BETHESDA

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20889-5638

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
202-782-6462

Provider Business Practice Location Address Fax Number:
202-782-0185

Provider Enumeration Date:
12/12/2006

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: 171000000X , with the licence number: D0035131 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Taxonomy code: 207RN0300X , with the licence number: D0035131 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .