1376643288 NPI number — TIMOTHY J. SWEENEY, P.C.

Table of content: (NPI 1376643288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376643288 NPI number — TIMOTHY J. SWEENEY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY J. SWEENEY, P.C.
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:
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:
1376643288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11244 WAPLES MILL RD
Provider Second Line Business Mailing Address:
SUITE K
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-6040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-359-4848
Provider Business Mailing Address Fax Number:
703-991-9130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11244 WAPLES MILL RD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-6040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-359-4848
Provider Business Practice Location Address Fax Number:
703-991-9130
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWEENEY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-359-4848

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S276 0001 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 143965 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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