1932281532 NPI number — GENE SWEETNAM, O.D., P.C.

Table of content: (NPI 1932281532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932281532 NPI number — GENE SWEETNAM, O.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENE SWEETNAM, O.D., P.C.
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:
1932281532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5204A ROLLING RD
Provider Second Line Business Mailing Address:
BURKE PROFESSIONAL CENTER
Provider Business Mailing Address City Name:
BURKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22015-1605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-425-2000
Provider Business Mailing Address Fax Number:
703-425-2003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5204A ROLLING RD
Provider Second Line Business Practice Location Address:
BURKE PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
BURKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22015-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-425-2000
Provider Business Practice Location Address Fax Number:
703-425-2003
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWEETNAM
Authorized Official First Name:
GENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-425-2000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618-000626 , 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)

  • Identifier: 0618000626 . This is a "VIRGINIA LICENSE NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com