1891201216 NPI number — MASTERPIECE INSTITUTE OF AESTHETICS AND GYNECOLOGY

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 1891201216 NPI number — MASTERPIECE INSTITUTE OF AESTHETICS AND GYNECOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASTERPIECE INSTITUTE OF AESTHETICS AND GYNECOLOGY
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:
1891201216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 ASPEN WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNDERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20689-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-569-0411
Provider Business Mailing Address Fax Number:
443-703-3201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 DEFENSE HWY STE 501
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-432-8534
Provider Business Practice Location Address Fax Number:
443-703-3201
Provider Enumeration Date:
12/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DUGAN
Authorized Official First Name:
KHADIJA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
443-569-0411

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  D0074779 , 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)





Copyright © 2007-2025 www.npivalidator.com