1477661130 NPI number — MS. MARGARET MARY DIVINCENZO M.S.

Table of content: MS. MARGARET MARY DIVINCENZO M.S. (NPI 1477661130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477661130 NPI number — MS. MARGARET MARY DIVINCENZO M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIVINCENZO
Provider First Name:
MARGARET
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIVINCENZO
Provider Other First Name:
PEGGY
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477661130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13890 BRADDOCK RD
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20121-2435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-502-9112
Provider Business Mailing Address Fax Number:
703-815-5663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13890 BRADDOCK RD
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20121-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-502-9112
Provider Business Practice Location Address Fax Number:
703-815-5663
Provider Enumeration Date:
08/25/2006

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: 101YM0800X , with the licence number:  0701001917 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 0717000895 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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