1528502036 NPI number — INTERDYNAMICS, INC

Table of content: (NPI 1528502036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528502036 NPI number — INTERDYNAMICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERDYNAMICS, 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:
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:
1528502036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 FORBES BLVD
Provider Second Line Business Mailing Address:
SUITE100
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-4807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-306-4590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 FORBES BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE100
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-4807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-306-4590
Provider Business Practice Location Address Fax Number:
301-880-0054
Provider Enumeration Date:
12/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BRANCH
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-306-4590

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  01660 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 01160 , 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: 535443 . This is a "PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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