1184863821 NPI number — MED INC

Table of content: (NPI 1184863821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184863821 NPI number — MED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1184863821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 REDLAND BLVD
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:
20850-5706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-656-7080
Provider Business Mailing Address Fax Number:
301-656-7082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8401 CONNECTICUT AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-656-7080
Provider Business Practice Location Address Fax Number:
301-656-7082
Provider Enumeration Date:
02/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DARJ
Authorized Official First Name:
ELNAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-656-7080

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P04981 , 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: 2134360 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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