1770655151 NPI number — DR. GUSTAVO RESTREPO MD

Table of content: DR. GUSTAVO RESTREPO MD (NPI 1770655151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770655151 NPI number — DR. GUSTAVO RESTREPO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RESTREPO
Provider First Name:
GUSTAVO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1770655151
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:
8955 EDMONSTON RD
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-4036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-441-9410
Provider Business Mailing Address Fax Number:
301-345-6671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8955 EDMONSTON RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-441-9410
Provider Business Practice Location Address Fax Number:
301-345-6671
Provider Enumeration Date:
11/14/2006

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: 208600000X , with the licence number:  D0008513 , 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: 27150 . This is a "MAMSI MD IPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0641053007 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08190001 . This is a "BLUE CHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1700201 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0819 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 30452 . This is a "JOHNE HOPKINS HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 455844 . This is a "US HEALTHCARE AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75676 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 488044 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6985 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0819 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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