1700212057 NPI number — GREAT EXPECTATIONS

Table of content: (NPI 1700212057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700212057 NPI number — GREAT EXPECTATIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT EXPECTATIONS
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:
6
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:
1700212057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6490 LANDOVER RD
Provider Second Line Business Mailing Address:
SUITE D ROOM #6
Provider Business Mailing Address City Name:
CHEVERLY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-200-8010
Provider Business Mailing Address Fax Number:
301-841-8016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6490 LANDOVER RD
Provider Second Line Business Practice Location Address:
SUITE D ROOM #6
Provider Business Practice Location Address City Name:
CHEVERLY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20785-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-200-8010
Provider Business Practice Location Address Fax Number:
301-841-8016
Provider Enumeration Date:
09/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KOROMA
Authorized Official First Name:
ABRAHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
301-200-8010

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  HCO171179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC2100X , with the licence number: HCO171179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , with the licence number: HCO171179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0200X , with the licence number: HCO171179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WW0000X , with the licence number: HCO171179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: HCO171179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X , with the licence number: HCO181179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 130702 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X , with the licence number: 130702 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 130702 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 130702 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: HCO171179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 130702 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 130702 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 130702 , 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)





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