1184702599 NPI number — DR. PHILIP LAURENCE MUSSENDEN SR. MD

Table of content: DR. SARA DYKOWSKI MD (NPI 1154982924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184702599 NPI number — DR. PHILIP LAURENCE MUSSENDEN SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSSENDEN
Provider First Name:
PHILIP
Provider Middle Name:
LAURENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1184702599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1647 BENNING ROAD, N.E.
Provider Second Line Business Mailing Address:
SUITE 300B
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20002-4588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-396-4774
Provider Business Mailing Address Fax Number:
202-396-8840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1647 BENNING ROAD, N.E.
Provider Second Line Business Practice Location Address:
SUITE 300B
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20002-4588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-396-4774
Provider Business Practice Location Address Fax Number:
202-396-8840
Provider Enumeration Date:
11/02/2006

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: 208D00000X , with the licence number:  MD25777 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005271000 . This is a "MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4278 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 022494800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871663200 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".