1497062178 NPI number — MEDICAL PRACTICE SOLUTIONS, LLC

Table of content: CHRISTOPHER WYKE SANGDAHL MD (NPI 1700838109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497062178 NPI number — MEDICAL PRACTICE SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL PRACTICE SOLUTIONS, 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:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497062178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8909 OLD BRANCH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-239-5888
Provider Business Mailing Address Fax Number:
202-403-0508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8909 OLD BRANCH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-239-5888
Provider Business Practice Location Address Fax Number:
202-403-0508
Provider Enumeration Date:
09/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARYANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
202-239-5888

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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