1134220874 NPI number — CAROL SANTUCCI

Table of content: CAROL SANTUCCI (NPI 1134220874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134220874 NPI number — CAROL SANTUCCI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTUCCI
Provider First Name:
CAROL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1134220874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 TUNLAW RD NW
Provider Second Line Business Mailing Address:
# 301
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20007-4807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-248-8828
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 17TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20036-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-255-5889
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2006

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: 1041C0700X , with the licence number:  LC303300 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 10513 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2129984 . This is a "MAMSI" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 355807 . This is a "MHN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 406124101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: K0400001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 7260639 . This is a "AETNA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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