1184019382 NPI number — NABESA NYOTA HERRING M.D.

Table of content: NABESA NYOTA HERRING M.D. (NPI 1184019382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184019382 NPI number — NABESA NYOTA HERRING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRING
Provider First Name:
NABESA
Provider Middle Name:
NYOTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1184019382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7450 ALBERT ROAD, 3RD FLOOR
Provider Second Line Business Mailing Address:
GREATER BADEN MEDICAL SERVICES
Provider Business Mailing Address City Name:
BRANDYWINE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-599-0460
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1458 ADDISON ROAD SOUTH
Provider Second Line Business Practice Location Address:
GREATER BADEN AT CAPITOL HEIGHTS
Provider Business Practice Location Address City Name:
CAPITOL HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-324-6405
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2015

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: 207Q00000X , with the licence number:  D0048294 , 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)





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