1124576095 NPI number — BLESSING JIM MATTHEWS MBPA, BS, BSN, RN

Table of content: BLESSING JIM MATTHEWS MBPA, BS, BSN, RN (NPI 1124576095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124576095 NPI number — BLESSING JIM MATTHEWS MBPA, BS, BSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
BLESSING JIM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBPA, BS, BSN, RN
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:
1124576095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8855 ANNAPOLIS RD
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-770-7774
Provider Business Mailing Address Fax Number:
240-770-3161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8855 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-770-7774
Provider Business Practice Location Address Fax Number:
240-770-3161
Provider Enumeration Date:
09/20/2016

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: 163WG0000X , with the licence number:  R129320 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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