1568689891 NPI number — JOHN DENDE LCPC

Table of content: JOHN DENDE LCPC (NPI 1568689891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568689891 NPI number — JOHN DENDE LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENDE
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
M

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:
1568689891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10402 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENSINGTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20895-3926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-910-4357
Provider Business Mailing Address Fax Number:
301-530-4020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 DRUID PARK LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21217-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-910-4357
Provider Business Practice Location Address Fax Number:
301-530-4020
Provider Enumeration Date:
04/19/2007

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: 101YP2500X , with the licence number:  LC1650 , 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: 001290401 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001290400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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