1376533661 NPI number — MRS. SUSAN TABAR ALLARD PA-C

Table of content: MRS. SUSAN TABAR ALLARD PA-C (NPI 1376533661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376533661 NPI number — MRS. SUSAN TABAR ALLARD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLARD
Provider First Name:
SUSAN
Provider Middle Name:
TABAR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLARD
Provider Other First Name:
SUE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1376533661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 DEWITT LOOP
Provider Second Line Business Mailing Address:
FORT BELVOIR COMMUNITY HOSPITAL - CARDIOLOGY DEPT
Provider Business Mailing Address City Name:
FORT BELVOIR
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-231-2006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 DEWITT LOOP
Provider Second Line Business Practice Location Address:
FORT BELVOIR COMMUNITY HOSPITAL - CARDIOLOGY DEPT
Provider Business Practice Location Address City Name:
FORT BELVOIR
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22060-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-231-2006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2005

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: 363AM0700X , with the licence number:  106081-1206 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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