Basic Information
Provider Information | |||||||||
NPI: | 1700064441 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEMET | ||||||||
FirstName: | MAYINUR | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BARAT | ||||||||
OtherFirstName: | MAYINUR | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 7014 BEDROCK ROAD | ||||||||
Address2: |   | ||||||||
City: | ALEXANDRIA | ||||||||
State: | VA | ||||||||
PostalCode: | 22306 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019435487 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5100 AUTH WAY | ||||||||
Address2: |   | ||||||||
City: | SUITLAND | ||||||||
State: | MD | ||||||||
PostalCode: | 20746 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3017025000 | ||||||||
FaxNumber: | 9413553243 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/05/2008 | ||||||||
LastUpdateDate: | 08/10/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/10/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X |   | MD | N |   | Other Service Providers | Acupuncturist |   | 171100000X | AP 2368 | FL | Y |   | Other Service Providers | Acupuncturist |   |
No ID Information.