1881617223 NPI number — MARIANNE S GARTEN L.P.C., C.S.O.T.P.

Table of content: MARIANNE S GARTEN L.P.C., C.S.O.T.P. (NPI 1881617223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881617223 NPI number — MARIANNE S GARTEN L.P.C., C.S.O.T.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARTEN
Provider First Name:
MARIANNE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.C., C.S.O.T.P.
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:
1881617223
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:
2014 TIMBERS HILL RD APT I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-3977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-320-0410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5412 GLENSIDE DR STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23228-3995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-282-5880
Provider Business Practice Location Address Fax Number:
804-288-2029
Provider Enumeration Date:
07/26/2006

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: 101YP2500X , with the licence number:  0701001708 , 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)





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