1992956775 NPI number — MOCAM INC

Table of content: (NPI 1992956775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992956775 NPI number — MOCAM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOCAM INC
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:
NONE
Provider Other Organization Name Type Code:
3
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:
1992956775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12320 EUGENES PROSPECT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20720-3373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-235-1907
Provider Business Mailing Address Fax Number:
240-235-1908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6323 GEORGIA AVE NW STE 206A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20011-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-291-2005
Provider Business Practice Location Address Fax Number:
202-722-2632
Provider Enumeration Date:
10/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOMAH
Authorized Official First Name:
EMEKA
Authorized Official Middle Name:
SAM
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
202-291-2005

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  DO034199 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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