1790217214 NPI number — CABIN JOHN PSYCHIATRY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790217214 NPI number — CABIN JOHN PSYCHIATRY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CABIN JOHN PSYCHIATRY, LLC
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:
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:
1790217214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 SEVEN LOCKS RD
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
CABIN JOHN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20818-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-320-3701
Provider Business Mailing Address Fax Number:
301-320-3774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 SEVEN LOCKS RD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
CABIN JOHN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20818-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-320-3701
Provider Business Practice Location Address Fax Number:
301-320-3774
Provider Enumeration Date:
04/03/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SORENSEN-TANENBAUM
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
NURSE PRACTITIONER/OFFICE MANAGER
Authorized Official Telephone Number:
301-741-6101

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  R160645 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: D19680 , 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)