=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396296125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAHMIN INVESTMENT GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2016
-----------------------------------------------------
Last Update Date | 10/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9301 SINGLETON DR
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-412-1963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9301 SINGLETON DR
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VAMSI ATREYA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-675-0507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 17739903
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------