1710175062 NPI number — MARILYN E CALDWELL SNYDER PA-C

Table of content: MARILYN E CALDWELL SNYDER PA-C (NPI 1710175062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710175062 NPI number — MARILYN E CALDWELL SNYDER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDWELL SNYDER
Provider First Name:
MARILYN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALDWELL
Provider Other First Name:
MARILYN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710175062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1522 SHELLBARK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20170-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22895 BRAMBLETON PLAZA
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BRAMBLETON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20148-4876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-726-0003
Provider Business Practice Location Address Fax Number:
703-726-6444
Provider Enumeration Date:
10/11/2007

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: 363AM0700X , with the licence number:  0110002635 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0110002635 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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