1508864273 NPI number — DR. LEWIS SUSKIEWICZ M.D.

Table of content: DR. LEWIS SUSKIEWICZ M.D. (NPI 1508864273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508864273 NPI number — DR. LEWIS SUSKIEWICZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUSKIEWICZ
Provider First Name:
LEWIS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1508864273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5510 ALMA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22151-4012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-642-5990
Provider Business Mailing Address Fax Number:
703-642-5003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPT. 6029
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20042-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-642-5990
Provider Business Practice Location Address Fax Number:
703-642-5003
Provider Enumeration Date:
07/07/2005

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: 207R00000X , with the licence number:  0101026006 , 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: 144512 . This is a "ONE HEALTH PLAN/GREAT WST" identifier . This identifiers is of the category "OTHER".
  • Identifier: P10011 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4092115 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4556-0008 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 723588 . This is a "FIRST HEALTH/AFFORDABLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0403505 . This is a "UNITED HEALTHCARE - MIDAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 257638 . This is a "ALLIANCE/MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 461901 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5325453-026 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0400439 . This is a "UNITED HEALTHCARE - VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 224016 . This is a "ANTHEM/TRIGON" identifier . This identifiers is of the category "OTHER".




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