1073653515 NPI number — NORTHERN VIRGINIA PSYCHIATRIC GROUP PC

Table of content: HANNAH LORRAINE COLLMANN LMSW (NPI 1003598764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073653515 NPI number — NORTHERN VIRGINIA PSYCHIATRIC GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN VIRGINIA PSYCHIATRIC GROUP PC
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:
1073653515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8500 EXECUTIVE PARK AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-698-5220
Provider Business Mailing Address Fax Number:
703-573-2351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7620 CARROLL AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TAKOMA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20912-6387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-698-5220
Provider Business Practice Location Address Fax Number:
703-573-2351
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAITHER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
703-698-5220

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1547 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 403204700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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