1205944634 NPI number — MS. DONELL DAWN DEREMER PA-C

Table of content: MS. DONELL DAWN DEREMER PA-C (NPI 1205944634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205944634 NPI number — MS. DONELL DAWN DEREMER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEREMER
Provider First Name:
DONELL
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1205944634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
629 BEAVER RUIN RD NW
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LILBURN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30047-3468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-921-4300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-876-0286
Provider Business Practice Location Address Fax Number:
410-876-0634
Provider Enumeration Date:
08/27/2006

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: 363A00000X , with the licence number:  C0001579 , 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)





Copyright © 2007-2025 www.npivalidator.com