1316222177 NPI number — VEIN HEALTH CENTER OF MARYLAND

Table of content: ELIZABETH ANNA KAUPPI MS OT (NPI 1881049906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316222177 NPI number — VEIN HEALTH CENTER OF MARYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEIN HEALTH CENTER OF MARYLAND
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316222177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9801 GEORGIA AVE
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-5276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-686-8555
Provider Business Mailing Address Fax Number:
301-593-9055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12013 BROAD MEADOW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21029-1258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-253-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VALI
Authorized Official First Name:
ASHA
Authorized Official Middle Name:
Authorized Official Title or Position:
RESIDENT AGENT
Authorized Official Telephone Number:
443-280-0255

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X , with the licence number:  D0052861 , 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)

  • Identifier: 490747 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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