1245413111 NPI number — MIRIAM WOODALL ROLAND MD PC

Table of content: (NPI 1245413111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245413111 NPI number — MIRIAM WOODALL ROLAND MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIRIAM WOODALL ROLAND MD PC
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:
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:
1245413111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6437 TUCKER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCLEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-241-1275
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 LITTLE FALLS ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-241-1275
Provider Business Practice Location Address Fax Number:
703-532-4201
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROLAND
Authorized Official First Name:
MIRIAM
Authorized Official Middle Name:
WOODALL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-893-4734

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  32097 , 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)

  • Identifier: G01295 . This is a "MEDICARE GROUP #" identifier . This identifiers is of the category "OTHER".




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