1609810431 NPI number — IRENE MARGARET VANGSNESS P.A.

Table of content: IRENE MARGARET VANGSNESS P.A. (NPI 1609810431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609810431 NPI number — IRENE MARGARET VANGSNESS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANGSNESS
Provider First Name:
IRENE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1609810431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 TURNHAM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-2619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-838-1991
Provider Business Mailing Address Fax Number:
301-947-9513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 RUSSELL AVE
Provider Second Line Business Practice Location Address:
SUITE # 1 SMC
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20879-3584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-869-0700
Provider Business Practice Location Address Fax Number:
301-947-9513
Provider Enumeration Date:
06/15/2006

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:  C0000827 , 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: C0000827 . This is a "MARYLAND CERT #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1011307 . This is a "NCCPA CERT#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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