1548441975 NPI number — JAVANSHIR JANANI,M.D., P.C

Table of content: (NPI 1548441975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548441975 NPI number — JAVANSHIR JANANI,M.D., P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAVANSHIR JANANI,M.D., P.C
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:
1548441975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 59425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20859-9425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-864-7100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5632 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
BLADENSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20710-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-864-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JANANI
Authorized Official First Name:
JAVANSHIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN / OWNER
Authorized Official Telephone Number:
301-864-7100

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  D0018630 , 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)

  • Identifier: 4531J . This is a "CAREFIRST BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0328 . This is a "CAREFIRST BLUESHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com