1891872016 NPI number — DR. MICHELLE LANIECE FUSELIER M.D.

Table of content: DR. MICHELLE LANIECE FUSELIER M.D. (NPI 1891872016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891872016 NPI number — DR. MICHELLE LANIECE FUSELIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUSELIER
Provider First Name:
MICHELLE
Provider Middle Name:
LANIECE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1891872016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6305 CASTLE PLACE
Provider Second Line Business Mailing Address:
SUITE 1D
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-533-5555
Provider Business Mailing Address Fax Number:
703-533-5596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6305 CASTLE PL
Provider Second Line Business Practice Location Address:
SUITE 1D
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22044-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-533-5555
Provider Business Practice Location Address Fax Number:
703-533-5596
Provider Enumeration Date:
11/01/2006

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: 207Q00000X , with the licence number:  0101240825 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: D0065265 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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