Provider Demographics
NPI:1558486993
Name:DOUGLAS, LONNIE (HS1)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:HS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 WISCONSIN AVE
Mailing Address - Street 2:BLDG. 5 ROOM 128A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-295-1659
Mailing Address - Fax:301-295-1651
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:BLDG. 5 ROOM 128A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-1659
Practice Address - Fax:301-295-1651
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other