1134852221 NPI number — KARA CAVANAUGH LEWIS BCAT

Table of content: KARA CAVANAUGH LEWIS BCAT (NPI 1134852221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134852221 NPI number — KARA CAVANAUGH LEWIS BCAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
KARA
Provider Middle Name:
CAVANAUGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCAT
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:
1134852221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 VILLAGE SQ STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21210-1624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-565-7222
Provider Business Mailing Address Fax Number:
877-934-1914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4141 N HENDERSON RD
Provider Second Line Business Practice Location Address:
PLAZA SUITE 7 & 8
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22203-2486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-565-7222
Provider Business Practice Location Address Fax Number:
877-734-1914
Provider Enumeration Date:
07/06/2022

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X , with the licence number: 00017612 , 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)





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