1134180433 NPI number — CAROLYN MARS ANGIOLI PNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134180433 NPI number — CAROLYN MARS ANGIOLI PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGIOLI
Provider First Name:
CAROLYN
Provider Middle Name:
MARS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARS
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
DEBRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN MS CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134180433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12950 HIGHLAND CROSSING DRIVE
Provider Second Line Business Mailing Address:
STE. H
Provider Business Mailing Address City Name:
HERNDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-860-4200
Provider Business Mailing Address Fax Number:
703-860-1528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12950 HIGHLAND CROSSING DRIVE
Provider Second Line Business Practice Location Address:
STE. H
Provider Business Practice Location Address City Name:
HERNDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-860-4200
Provider Business Practice Location Address Fax Number:
703-860-1528
Provider Enumeration Date:
03/28/2006

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:  0017001234 , 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: 007788452 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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