1528096690 NPI number — SUBURBAN HOSPITAL, INC.

Table of content: (NPI 1528096690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528096690 NPI number — SUBURBAN HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUBURBAN HOSPITAL, INC.
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:
1528096690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8600 OLD GEORGETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-1422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-896-3901
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 ROCKLEDGE DR
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-7837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-896-3901
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAGNOLATI
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-896-2574

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  15332 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QI0500X , with the licence number: 15332 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0203X , with the licence number: 15332 , 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: 715 . This is a "BLUE CROSS OF NCA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 419126900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57352101 . This is a "BLUE CROSS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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