1336193887 NPI number — STAGGERS HEARE & WHITEMAN PA

Table of content: KYLEE BETH WEIDENBENNER MA, SLP (NPI 1801623582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336193887 NPI number — STAGGERS HEARE & WHITEMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAGGERS HEARE & WHITEMAN PA
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:
6
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:
1336193887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11801 UPPER POTOMAC INDSTRL PARK ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-5139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-729-3485
Provider Business Mailing Address Fax Number:
301-729-0158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11801 UPPER POTOMAC INDSTRL PARK ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-729-3485
Provider Business Practice Location Address Fax Number:
301-729-0158
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITEMAN, JR.
Authorized Official First Name:
ROY
Authorized Official Middle Name:
DAVID RUSSELL
Authorized Official Title or Position:
PRESIDENT/OFFICER
Authorized Official Telephone Number:
301-729-3485

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116441251494 . This is a "HUMANA INSURANCE CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: CM4138 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: R950 . This is a "CAREFIRST BCBS OF DC NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: S986 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1017320 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810003745 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11015 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5766011 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810003745 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222830 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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