1326109620 NPI number — DR. MARY E KEGELMAN DNP, FNP-BC

Table of content: DR. MARY E KEGELMAN DNP, FNP-BC (NPI 1326109620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326109620 NPI number — DR. MARY E KEGELMAN DNP, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEGELMAN
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, FNP-BC
Provider Gender Code:
F

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:
1326109620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
193 CHRISTINA LANDING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801-5253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-593-2562
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHAMPLAIN MILL, 20 WINOOSKI FALLS WAY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
WINOOSKI
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-530-8906
Provider Business Practice Location Address Fax Number:
302-351-7388
Provider Enumeration Date:
12/12/2006

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: 363LF0000X , with the licence number:  LG-0001079 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024166503 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 95835 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010165512 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7003738 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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