1477829109 NPI number — BEACKY BIH

Table of content: BEACKY BIH (NPI 1477829109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477829109 NPI number — BEACKY BIH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIH
Provider First Name:
BEACKY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1477829109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30283 TRIANGLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE HALL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20622-3125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-472-1825
Provider Business Mailing Address Fax Number:
301-472-1867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
SUITE 323
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20012-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-723-3060
Provider Business Practice Location Address Fax Number:
202-723-3065
Provider Enumeration Date:
03/27/2012

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: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 28509 , 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)