1255360541 NPI number — LOUISE CAROLYN WASHINGTON-ALSTON M.D.

Table of content: LOUISE CAROLYN WASHINGTON-ALSTON M.D. (NPI 1255360541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255360541 NPI number — LOUISE CAROLYN WASHINGTON-ALSTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON-ALSTON
Provider First Name:
LOUISE
Provider Middle Name:
CAROLYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1255360541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6372 MECHANICSVILLE TPKE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MECHANICSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23111-4705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-730-4690
Provider Business Mailing Address Fax Number:
804-559-0333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6372 MECHANICSVILLE TPKE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23111-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-730-4690
Provider Business Practice Location Address Fax Number:
804-559-0333
Provider Enumeration Date:
07/01/2006

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: 208000000X , with the licence number:  0101046419 , 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: 74209 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4139089 . This is a "AETNA LIFE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 254777 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 79169 . This is a "SOUTHERN HEALTH SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006711758 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103171 . This is a "ANTHEM BCBS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5832832 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4139089 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com