1407056336 NPI number — GERALD FAMILY CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407056336 NPI number — GERALD FAMILY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD FAMILY CARE
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:
1407056336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 75492
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275-5492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-773-3752
Provider Business Mailing Address Fax Number:
202-529-5290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 VARNUM ST NE
Provider Second Line Business Practice Location Address:
STE 117
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20017-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-832-7007
Provider Business Practice Location Address Fax Number:
202-529-5290
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
301-773-3752

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8702 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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