1275774184 NPI number — DR. LINDA JEAN CIMARUSTI PH.D.

Table of content: DR. LINDA JEAN CIMARUSTI PH.D. (NPI 1275774184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275774184 NPI number — DR. LINDA JEAN CIMARUSTI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIMARUSTI
Provider First Name:
LINDA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CIMARUSTI
Provider Other First Name:
MARYLINDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275774184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7910 WOODMONT AVE
Provider Second Line Business Mailing Address:
SUITE 1101
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-509-8592
Provider Business Mailing Address Fax Number:
310-229-9008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7910 WOODMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 1101
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-509-8592
Provider Business Practice Location Address Fax Number:
310-229-9008
Provider Enumeration Date:
03/23/2009

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: 103TC0700X , with the licence number:  01674 , 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)





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