1750500864 NPI number — DR. DEBRA M BLOCK D.C.

Table of content: DR. DEBRA M BLOCK D.C. (NPI 1750500864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750500864 NPI number — DR. DEBRA M BLOCK D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOCK
Provider First Name:
DEBRA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1750500864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3919 NATIONAL DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
BURTONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20866-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-476-7575
Provider Business Mailing Address Fax Number:
301-476-7730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3919 NATIONAL DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BURTONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20866-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-476-7575
Provider Business Practice Location Address Fax Number:
301-476-7730
Provider Enumeration Date:
04/25/2007

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: 111N00000X , with the licence number:  02149 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NR0400X , with the licence number: 02149 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: G01419 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41519201 . This is a "BCBS RENDERING #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com