1134102767 NPI number — DR. PEDRO SARMIENTO JR. M.D.

Table of content: BETHANY CAMPBELL RN (NPI 1518626563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134102767 NPI number — DR. PEDRO SARMIENTO JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARMIENTO
Provider First Name:
PEDRO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1134102767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11885 HOLLY LN
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20601-3181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-932-5299
Provider Business Mailing Address Fax Number:
301-645-9442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11885 HOLLY LANE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-932-5299
Provider Business Practice Location Address Fax Number:
301-645-9442
Provider Enumeration Date:
11/29/2005

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: 208000000X , with the licence number:  D0039620 , 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)

  • Identifier: 1982753877 . This is a "GROUP NPI FOR PEDIATRIC AFTER HOURS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 188876-192159 . This is a "BCBS VA PIN FOR PEDIATRIC AFTER HOURS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: KH18PE-52297105 . This is a "BCBS MD PIN FOR PEDIATRIC AFTER HOURS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5228-0007 . This is a "BCBS NCA PIN FOR PEDIATRIC AFTER HOURS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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