1093216665 NPI number — MR. DAMIAN AARON PACE JR. NRP, FP-C, CCP-C

Table of content: MR. DAMIAN AARON PACE JR. NRP, FP-C, CCP-C (NPI 1093216665)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093216665 NPI number — MR. DAMIAN AARON PACE JR. NRP, FP-C, CCP-C

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
PACE

Provider First Name:
DAMIAN

Provider Middle Name:
AARON

Provider Name Prefix Text:
MR.

Provider Name Suffix Text:
JR.

Provider Credential Text:
NRP, FP-C, CCP-C

Provider Gender Code:
M

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:
1093216665

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
02/28/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 N HIGHVIEW LN APT 206

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
ALEXANDRIA

Provider Business Mailing Address State Name:
VA

Provider Business Mailing Address Postal Code:
22311-2346

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
203-817-2152

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N HIGHVIEW LN APT 206

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
ALEXANDRIA

Provider Business Practice Location Address State Name:
VA

Provider Business Practice Location Address Postal Code:
22311-2346

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
203-817-2152

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
02/28/2018

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: 146L00000X , with the licence number: E201402677 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .