Provider Demographics
NPI:1891086203
Name:CVM-PRINCE FREDERICK, LLC
Entity Type:Organization
Organization Name:CVM-PRINCE FREDERICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:ARUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAPAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-860-0003
Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-860-0003
Mailing Address - Fax:
Practice Address - Street 1:301 STEEPLE CHASE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4049
Practice Address - Country:US
Practice Address - Phone:410-535-9282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty