1811068729 NPI number — SUZANNE C AMORUSO RD, CDE

Table of content: SUZANNE C AMORUSO RD, CDE (NPI 1811068729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811068729 NPI number — SUZANNE C AMORUSO RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMORUSO
Provider First Name:
SUZANNE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAGGIULLI
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811068729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21975
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-321-4281
Provider Business Mailing Address Fax Number:
540-321-4282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 SUNSET LN STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULPEPER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22701-3979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-825-4557
Provider Business Practice Location Address Fax Number:
540-825-4566
Provider Enumeration Date:
11/13/2006

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1811068729 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q58686A . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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