1568533099 NPI number — CAROLYN B. HENDRICKS, MD, PA

Table of content: (NPI 1568533099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568533099 NPI number — CAROLYN B. HENDRICKS, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLYN B. HENDRICKS, MD, PA
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:
1568533099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6410 ROCKLEDGE DR
Provider Second Line Business Mailing Address:
SUITE 506
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20817-1809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-897-1503
Provider Business Mailing Address Fax Number:
301-581-0254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 ROCKLEDGE DR
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-7822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-897-1503
Provider Business Practice Location Address Fax Number:
301-581-0254
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEMOND
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
301-897-1503

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0037236 , 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: 1212579 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4318989 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 670109 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 470CCB . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N060 0001 . This is a "BCBS NCA FEP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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