1710680129 NPI number — ASHLEE BROOKE VARGASON MGC, CGC

Table of content: ASHLEE BROOKE VARGASON MGC, CGC (NPI 1710680129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710680129 NPI number — ASHLEE BROOKE VARGASON MGC, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGASON
Provider First Name:
ASHLEE
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MGC, CGC
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:
1710680129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2414 PINEVILLE CREST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODENTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21113-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-618-2206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 ST PAUL PLACE
Provider Second Line Business Practice Location Address:
3RD FLOOR OF WEINBERG
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-951-7950
Provider Business Practice Location Address Fax Number:
410-951-7931
Provider Enumeration Date:
03/24/2023

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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