1972523785 NPI number — MRS. MAUREEN HABERMAN VON BREDOW NP

Table of content: MRS. MAUREEN HABERMAN VON BREDOW NP (NPI 1972523785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972523785 NPI number — MRS. MAUREEN HABERMAN VON BREDOW NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VON BREDOW
Provider First Name:
MAUREEN
Provider Middle Name:
HABERMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1972523785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2217 LOVEDALE LN
Provider Second Line Business Mailing Address:
APPARTMENT J
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20191-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-993-2833
Provider Business Mailing Address Fax Number:
703-993-4365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
MS 2D3
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-4422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-993-2833
Provider Business Practice Location Address Fax Number:
703-993-4365
Provider Enumeration Date:
07/21/2006

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: 363LF0000X , with the licence number:  0024164075 , 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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