1023283967 NPI number — DAMASK PHYSICIANS GROUP PLLC

Table of content: (NPI 1023283967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023283967 NPI number — DAMASK PHYSICIANS GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAMASK PHYSICIANS GROUP PLLC
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:
6
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:
1023283967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
795 PRIMERA BLVD
Provider Second Line Business Mailing Address:
SUITE 1031
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-2191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-829-8981
Provider Business Mailing Address Fax Number:
407-942-1049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
795 PRIMERA BLVD
Provider Second Line Business Practice Location Address:
SUITE 1031
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-2191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-829-8981
Provider Business Practice Location Address Fax Number:
407-942-1049
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DAMASK
Authorized Official First Name:
CECELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
407-829-8981

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YX0602X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: FD6869861 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com