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General NPI Number Information
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NPI Number | 1003240722
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Entity Type | Organization
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Legal Business Name | MAKING A DIFFERENCE INC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 12781 DARBY BROOK CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2482
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Country | US
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Telephone | 571-243-1845
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Fax |
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Provider Business Mailing Address
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Address Line | 12781 DARBY BROOK CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2482
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Country | US
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Telephone | 571-243-1845
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ORLANDO SMALL
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Credential |
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Telephone | 202-436-5386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 302F00000X
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License Number State | VA
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