1376544486 NPI number — DR. TIK KA LISA NG M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376544486 NPI number — DR. TIK KA LISA NG M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NG

Provider First Name:

TIK KA

Provider Middle Name:

LISA

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1376544486

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/19/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4000 OLNEY LAYTONSVILLE RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

OLNEY

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20832-1802

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

301-774-2506

Provider Business Mailing Address Fax Number:

301-774-3734

Provider First Line Business Practice Location Address:

4000 OLNEY LAYTONSVILLE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OLNEY

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20832-1802

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-774-2506

Provider Business Practice Location Address Fax Number:

301-774-3734

Provider Enumeration Date:

08/10/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  D0055931 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 7605-0062 . This is a "CAREFIRST BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 8120765 . This is a "MAMSI PRIMARY CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 0989033 . This is a "CIGNA PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 2097791 . This is a "UHC PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 2120765 . This is a "MAMSI SPECIALIST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: P16105 . This is a "CAREFIRST MPOS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: D0055931 . This is a "MHIP PROVIDER ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 607673-03 . This is a "CAREFIRST MD RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 125716 . This is a "JHHC PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 2619428 . This is a "AETNA CAPITATED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 7104241 . This is a "AETNA FEE FOR SERVICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".