1235164641 NPI number — MS. MICHELE SUZAN GITTINGS PA C

Table of content: MS. MICHELE SUZAN GITTINGS PA C (NPI 1235164641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235164641 NPI number — MS. MICHELE SUZAN GITTINGS PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GITTINGS
Provider First Name:
MICHELE
Provider Middle Name:
SUZAN
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:
KOVALCIK
Provider Other First Name:
MICHELE
Provider Other Middle Name:
SUZAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235164641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13700
Provider Second Line Business Mailing Address:
COMMONWEALTH EMERGENCY PHYSICIANS PC
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19191-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-777-2455
Provider Business Mailing Address Fax Number:
610-617-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44045 RIVERSIDE PKWY
Provider Second Line Business Practice Location Address:
LOUDOUN HOSPITAL CENTER
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-5101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-858-6044
Provider Business Practice Location Address Fax Number:
610-617-6280
Provider Enumeration Date:
07/12/2006

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:  0110 001865 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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