1831166487 NPI number — JACQUELYN B. DUNMORE-GRIFFITH MD

Table of content: JACQUELYN B. DUNMORE-GRIFFITH MD (NPI 1831166487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831166487 NPI number — JACQUELYN B. DUNMORE-GRIFFITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNMORE-GRIFFITH
Provider First Name:
JACQUELYN
Provider Middle Name:
B.
Provider Name Prefix Text:
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:
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:
1831166487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 418837
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-8837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-542-3060
Provider Business Mailing Address Fax Number:
240-542-3061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8116 GOOD LUCK RD STE LL05
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-542-3060
Provider Business Practice Location Address Fax Number:
240-542-3061
Provider Enumeration Date:
03/02/2006

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: 2085R0001X , with the licence number:  MD20575 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: D0046901 , 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: 500000901 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00458394 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 714014200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002 . This is a "BCBS DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 011624500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01178473 . This is a "AMERIGROUP PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 621105-03 . This is a "BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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