1073878203 NPI number — ELIZABETH ABBEY LYNN ANDRULEWICZ DPT

Table of content: ELIZABETH ABBEY LYNN ANDRULEWICZ DPT (NPI 1073878203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073878203 NPI number — ELIZABETH ABBEY LYNN ANDRULEWICZ DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDRULEWICZ
Provider First Name:
ELIZABETH
Provider Middle Name:
ABBEY LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1073878203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11240 WAPLES MILL RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-6078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-237-2219
Provider Business Mailing Address Fax Number:
703-237-2729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
998 HOSPITALITY WAY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21001-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-273-9776
Provider Business Practice Location Address Fax Number:
410-273-9777
Provider Enumeration Date:
07/13/2012

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: 225100000X , with the licence number:  24064 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: 2305209066 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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