1326018250 NPI number — DR. LUBRINA ESTELLA BRYANT DPM

Table of content: DR. LUBRINA ESTELLA BRYANT DPM (NPI 1326018250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326018250 NPI number — DR. LUBRINA ESTELLA BRYANT DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYANT
Provider First Name:
LUBRINA
Provider Middle Name:
ESTELLA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOUIS-JACQUES
Provider Other First Name:
LUBRINA
Provider Other Middle Name:
ESTELLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326018250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1647 BENNING RD NE
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20002-4570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-388-5303
Provider Business Mailing Address Fax Number:
202-388-5305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1647 BENNING RD NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20002-4570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-388-5303
Provider Business Practice Location Address Fax Number:
202-388-5305
Provider Enumeration Date:
01/24/2006

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: 213E00000X , with the licence number:  0103300768 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: P01000007 , 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)

  • Identifier: 4699 . This is a "BRAVO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0187 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1471929 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2155212 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: T1477 . This is a "HEALTH RIGHT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22390 . This is a "DC CHARTERED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480032058 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 490512 . This is a "MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 4699 . This is a "ELDER HEALTH" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 480000714 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 017242700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9304151 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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