1477701217 NPI number — DISTRICT PODIATRY, PLLC

Table of content: (NPI 1477701217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477701217 NPI number — DISTRICT PODIATRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISTRICT PODIATRY, PLLC
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:
1477701217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1647 BENNING RD NE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20002-4569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-388-5303
Provider Business Mailing Address Fax Number:
202-388-5305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1647 BENNING RD NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20002-4569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-388-5303
Provider Business Practice Location Address Fax Number:
202-388-5305
Provider Enumeration Date:
09/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOUIS-JACQUES
Authorized Official First Name:
LUBRINA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
202-388-5303

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  0103300768 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: P01000007 , 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)

  • Identifier: 22390 . This is a "DC CHARTERED" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 480032058 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4699 . This is a "BRAVO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 9304151 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0170242700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2155212 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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