1386070787 NPI number — DR. JUSTINE MCDERMOTT AUD

Table of content: DR. JUSTINE MCDERMOTT AUD (NPI 1386070787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386070787 NPI number — DR. JUSTINE MCDERMOTT AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
JUSTINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
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:
1386070787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 UNIVERSITY DR 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-383-8130
Provider Business Mailing Address Fax Number:
703-383-7353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8650 SUDLEY RD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-369-0300
Provider Business Practice Location Address Fax Number:
703-369-0017
Provider Enumeration Date:
09/18/2013

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: 231H00000X , with the licence number:  2201001528 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2201001528 . This is a "VA STATE AUDIOLOGY LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com