1295087187 NPI number — MR. KEITH BARRINGTON VANDERPOOL BS RPSGT, RST, CSE

Table of content: MR. KEITH BARRINGTON VANDERPOOL BS RPSGT, RST, CSE (NPI 1295087187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295087187 NPI number — MR. KEITH BARRINGTON VANDERPOOL BS RPSGT, RST, CSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERPOOL BS
Provider First Name:
KEITH
Provider Middle Name:
BARRINGTON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPSGT, RST, CSE
Provider Gender Code:
M

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:
1295087187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9701 APOLLO DR STE 3309701
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-4783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-925-4510
Provider Business Mailing Address Fax Number:
301-925-4510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9701 APOLLO DR STE 3309701
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-925-4510
Provider Business Practice Location Address Fax Number:
301-925-4510
Provider Enumeration Date:
10/03/2012

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: 247200000X , with the licence number:  Z0000042 , 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)





Copyright © 2007-2025 www.npivalidator.com