1013958206 NPI number — DR. SHERRYL JESSICA PETERSEN TOMASINO PH.D.

Table of content: DR. SHERRYL JESSICA PETERSEN TOMASINO PH.D. (NPI 1013958206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013958206 NPI number — DR. SHERRYL JESSICA PETERSEN TOMASINO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSEN TOMASINO
Provider First Name:
SHERRYL
Provider Middle Name:
JESSICA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1013958206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41921 WHITE POINT BEACH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-5736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-751-4717
Provider Business Mailing Address Fax Number:
301-475-2102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22660 WASHNGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650-0604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-475-2020
Provider Business Practice Location Address Fax Number:
301-475-2102
Provider Enumeration Date:
06/09/2006

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: 103TC0700X , with the licence number:  O1671 , 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)





Copyright © 2007-2025 www.npivalidator.com