1588238950 NPI number — CYNTHIA MICHELLE TAWNEY ADT 2421

Table of content: CYNTHIA MICHELLE TAWNEY ADT 2421 (NPI 1588238950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588238950 NPI number — CYNTHIA MICHELLE TAWNEY ADT 2421

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAWNEY
Provider First Name:
CYNTHIA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ADT 2421
Provider Gender Code:
F

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:
1588238950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1557 PATUXENT MANOR CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVIDSONVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21035-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-716-6789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2669A SOLOMONS ISLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21037-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-440-5780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2021

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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