1457738122 NPI number — MEDICAL AMBASSADOR HEALTHCARE, LLC

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 1457738122 NPI number — MEDICAL AMBASSADOR HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL AMBASSADOR HEALTHCARE, LLC
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:
6
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:
1457738122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 L ST NW
Provider Second Line Business Mailing Address:
SUITE 100-275
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20005-4018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-705-2455
Provider Business Mailing Address Fax Number:
202-315-2511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 L ST NW
Provider Second Line Business Practice Location Address:
SUITE 100-275
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20005-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-705-2455
Provider Business Practice Location Address Fax Number:
202-315-2511
Provider Enumeration Date:
05/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AWANDA
Authorized Official First Name:
CAMILLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-343-7514

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  RN1004831 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com