1912066747 NPI number — MR. NAJIBULLAH SAYED STOMAN PA

Table of content: ANNA THERESA HESCHMEYER (NPI 1295368777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912066747 NPI number — MR. NAJIBULLAH SAYED STOMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOMAN
Provider First Name:
NAJIBULLAH
Provider Middle Name:
SAYED
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1912066747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 SETTLER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEILACOOM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98388-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-588-5281
Provider Business Mailing Address Fax Number:
253-512-6645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 SETTLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEILACOOM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98388-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-588-5281
Provider Business Practice Location Address Fax Number:
253-512-6645
Provider Enumeration Date:
12/07/2006

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: 363A00000X , with the licence number:  PA10001570 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183700000X , with the licence number: VA00015779 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8350423 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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