1023179314 NPI number — METROPOLITAN WOMEN'S GROUP, LLC

Table of content: (NPI 1023179314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023179314 NPI number — METROPOLITAN WOMEN'S GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN WOMEN'S GROUP, LLC
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:
1023179314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 SPRING STREET
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-585-8796
Provider Business Mailing Address Fax Number:
301-565-8079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7701 GREENBELT ROAD
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-513-0200
Provider Business Practice Location Address Fax Number:
301-513-0555
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAYTON
Authorized Official First Name:
CATHRYN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
301-585-8796

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  DOO50472 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: DOO48033 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: DOO50606 , 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)

  • Identifier: A699 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: G400 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3000-01 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 462200 . This is a "ANTHEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KEN7ME . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 400599600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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