1609896489 NPI number — ERICKSON HEALTH MEDICAL GROUP OF VIRGINIA PC

Table of content: (NPI 1609896489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609896489 NPI number — ERICKSON HEALTH MEDICAL GROUP OF VIRGINIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERICKSON HEALTH MEDICAL GROUP OF VIRGINIA PC
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:
GREENSPRING MEDICAL CENTER
Provider Other Organization Name Type Code:
5
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:
1609896489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 EXECUTIVE DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-923-4644
Provider Business Mailing Address Fax Number:
703-923-4625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7440 SPRING VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22150-4446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-923-4644
Provider Business Practice Location Address Fax Number:
703-923-4625
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NARRETT
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR VP AND CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
410-402-2257

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04-53885 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350541 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: LS89SE . This is a "BCBS VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006 . This is a "CAREFIRST OF DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5374 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 346802 . This is a "CAREFIRST OF MD" identifier . This identifiers is of the category "OTHER".




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