1265552954 NPI number — DR. GERALD NELSON DOUGLASSHARPER NMD

Table of content: DR. GERALD NELSON DOUGLASSHARPER NMD (NPI 1265552954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265552954 NPI number — DR. GERALD NELSON DOUGLASSHARPER NMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUGLASSHARPER
Provider First Name:
GERALD
Provider Middle Name:
NELSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
NMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARPER
Provider Other First Name:
GERALD
Provider Other Middle Name:
NELSON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265552954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4205 58TH AVE
Provider Second Line Business Mailing Address:
APT. 6
Provider Business Mailing Address City Name:
BLADENSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20710-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-326-3515
Provider Business Mailing Address Fax Number:
202-544-6820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
641 PENNSYLVANIA AVE SE
Provider Second Line Business Practice Location Address:
STE. # 1
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20003-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-544-4478
Provider Business Practice Location Address Fax Number:
202-544-6820
Provider Enumeration Date:
03/29/2007

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: 175F00000X , with the licence number:  NAT 286 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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