1447222088 NPI number — DR. MAVA BRIANA ROBINSON-WALTON MD

Table of content: DR. MAVA BRIANA ROBINSON-WALTON MD (NPI 1447222088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447222088 NPI number — DR. MAVA BRIANA ROBINSON-WALTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON-WALTON
Provider First Name:
MAVA
Provider Middle Name:
BRIANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALTON
Provider Other First Name:
BRIANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447222088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8110 MAPLE LAWN BLVD
Provider Second Line Business Mailing Address:
STE 235
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-2694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-340-8339
Provider Business Mailing Address Fax Number:
301-340-9027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10301 GEORGIA AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-592-1600
Provider Business Practice Location Address Fax Number:
301-592-1602
Provider Enumeration Date:
02/07/2006

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: 207V00000X , with the licence number:  D0060942 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD33866 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VF0040X , with the licence number: D60942 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 511206100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7984083 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93604502 . This is a "BCBS MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: D60942 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1782731 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006205551 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034192800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: X3640002 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 511206101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93604504 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N4350001 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010216249 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93604503 . This is a "BCBS MARYLAND" identifier . This identifiers is of the category "OTHER".




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