1861485047 NPI number — RICHARD ST.CLAIR SQUIRES M.D.

Table of content: RICHARD ST.CLAIR SQUIRES M.D. (NPI 1861485047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861485047 NPI number — RICHARD ST.CLAIR SQUIRES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SQUIRES
Provider First Name:
RICHARD
Provider Middle Name:
ST.CLAIR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1861485047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
198 HALPINE RD
Provider Second Line Business Mailing Address:
1319
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-1661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-984-3124
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7610 CARROLL AVE
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
TAKOMA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20912-6384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-891-2891
Provider Business Practice Location Address Fax Number:
301-891-2892
Provider Enumeration Date:
08/24/2005

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: 207RP1001X , with the licence number:  D56953 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: MD22067 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4432870 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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