1497817373 NPI number — MRS. CLAUDETTE EMMELINE DEMETRIUS

Table of content: MRS. CLAUDETTE EMMELINE DEMETRIUS (NPI 1497817373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497817373 NPI number — MRS. CLAUDETTE EMMELINE DEMETRIUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMETRIUS
Provider First Name:
CLAUDETTE
Provider Middle Name:
EMMELINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1497817373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13529 GEORGIA AVE
Provider Second Line Business Mailing Address:
APARTMENT 203
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-946-3338
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16220 FREDRICK AVE
Provider Second Line Business Practice Location Address:
#12
Provider Business Practice Location Address City Name:
GEITHERSBERG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-208-0775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006

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: 374U00000X , with the licence number:  991558 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WG0600X , with the licence number: A00015852 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: A00015852 . This is a "CERTIFIED GERIATRIC NURSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4387007-00 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 714564100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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