1295880003 NPI number — DR. REGINALD MATTHEW BIGGS M.D.

Table of content: DR. REGINALD MATTHEW BIGGS M.D. (NPI 1295880003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295880003 NPI number — DR. REGINALD MATTHEW BIGGS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIGGS
Provider First Name:
REGINALD
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1295880003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
829 SHERIDAN ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20011-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-829-6010
Provider Business Mailing Address Fax Number:
202-829-1481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3731 BRANCH AVE
Provider Second Line Business Practice Location Address:
SUITE# B-309
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-316-4456
Provider Business Practice Location Address Fax Number:
301-316-4469
Provider Enumeration Date:
01/24/2007

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: 2084P0800X , with the licence number:  D0054306 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: MD31121 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 288826 . This is a "AMERIGROUP DC MEDICAID#" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 4838 . This is a "BLUE X B SHIELD#" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 123805 . This is a "CHARTERED HEALTH#" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 132499 . This is a "VALUE OPTIONS PROV.#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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