1164427704 NPI number — JANICE POSTAL DPM

Table of content: JANICE POSTAL DPM (NPI 1164427704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164427704 NPI number — JANICE POSTAL DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POSTAL
Provider First Name:
JANICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1164427704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11125 ROCKVILLE PIKE STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-3142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-681-6008
Provider Business Mailing Address Fax Number:
301-681-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 ROCKVILLE PIKE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-681-6008
Provider Business Practice Location Address Fax Number:
301-681-8908
Provider Enumeration Date:
06/20/2005

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: 213EP1101X , with the licence number:  960 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 960 , 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: 41937701 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 479168100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32445 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5598-0001 . This is a "BLUE CROSS BLUE SHIELD NCA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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