1780650143 NPI number — DR. DEBORA ANN MIHALEY-SOBELMAN MD

Table of content: DR. DEBORA ANN MIHALEY-SOBELMAN MD (NPI 1780650143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780650143 NPI number — DR. DEBORA ANN MIHALEY-SOBELMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIHALEY-SOBELMAN
Provider First Name:
DEBORA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIHALEY-SOBELMAN
Provider Other First Name:
DEBORA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780650143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 RIVERMONT AVE APT 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24503-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-836-1551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010 ATHERHOLT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24501-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-200-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2006

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: 207QH0002X , with the licence number:  PENDING , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 037402 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QH0002X , with the licence number: 0101269171 , 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)

  • Identifier: 004236007 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".