1558510909 NPI number — THERESA DONOHUE JERUSSI MS, PA-C

Table of content: THERESA DONOHUE JERUSSI MS, PA-C (NPI 1558510909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558510909 NPI number — THERESA DONOHUE JERUSSI MS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JERUSSI
Provider First Name:
THERESA
Provider Middle Name:
DONOHUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONOHUE
Provider Other First Name:
THERESA
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558510909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CENTER DRIVE MSC 1202
Provider Second Line Business Mailing Address:
BUILDING 10, CRC RM 3-5272
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20892-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-594-8003
Provider Business Mailing Address Fax Number:
301-480-0195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CENTER DRIVE MSC 1202
Provider Second Line Business Practice Location Address:
BUILDING 10, CRC RM 3-5272
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-594-8003
Provider Business Practice Location Address Fax Number:
301-480-0195
Provider Enumeration Date:
09/10/2008

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: 363A00000X , with the licence number:  C0002298 , 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)





Copyright © 2007-2025 www.npivalidator.com