1104976349 NPI number — SUSAN L RHINELANDER NP

Table of content: SUSAN L RHINELANDER NP (NPI 1104976349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104976349 NPI number — SUSAN L RHINELANDER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHINELANDER
Provider First Name:
SUSAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1104976349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 SEABOARD RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23456-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-430-4270
Provider Business Mailing Address Fax Number:
949-695-3748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 SEABOARD RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-430-4270
Provider Business Practice Location Address Fax Number:
949-695-3748
Provider Enumeration Date:
01/11/2007

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: 363L00000X , with the licence number:  NP14814 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024164697 , 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)

  • Identifier: RN633860 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3001743669-0002 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105858100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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