1386913762 NPI number — CAROL ANN VAN RYZIN NP

Table of content: CAROL ANN VAN RYZIN NP (NPI 1386913762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386913762 NPI number — CAROL ANN VAN RYZIN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN RYZIN
Provider First Name:
CAROL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1386913762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NIH CLINICAL CTR
Provider Second Line Business Mailing Address:
BUILDING 10, CRC , ROOM 1-2742
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20892-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-451-0399
Provider Business Mailing Address Fax Number:
301-480-3932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NIH CLINICAL CTR
Provider Second Line Business Practice Location Address:
BUILDING 10, CRC , ROOM 1-2742
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-451-0399
Provider Business Practice Location Address Fax Number:
301-480-3932
Provider Enumeration Date:
12/14/2011

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: 363LP0200X , with the licence number:  R134751 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WP0200X , with the licence number: R134751 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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