1952358848 NPI number — RALPH W. FAWCETT

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 1952358848 NPI number — RALPH W. FAWCETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALPH W. FAWCETT
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:
1952358848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20861-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-9700
Provider Business Mailing Address Fax Number:
301-260-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 LAUREL BOWIE RD
Provider Second Line Business Practice Location Address:
SUITE 209D
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-262-5203
Provider Business Practice Location Address Fax Number:
301-262-3909
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FAWCETT
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
WILLARD
Authorized Official Title or Position:
PRINCIPAL OWNER
Authorized Official Telephone Number:
301-262-5203

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  D0029737 , 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)





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