Provider Demographics
NPI:1053617670
Name:COLDSTREAM SOLUTIONS, INC.
Entity type:Organization
Organization Name:COLDSTREAM SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARANTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-553-7003
Mailing Address - Street 1:4410 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE 234
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-5561
Mailing Address - Country:US
Mailing Address - Phone:202-553-7003
Mailing Address - Fax:202-207-2803
Practice Address - Street 1:4410 MASSACHUSETTS AVE NW
Practice Address - Street 2:SUITE 234
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-5561
Practice Address - Country:US
Practice Address - Phone:202-553-7003
Practice Address - Fax:202-207-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD8087OtherLICENSE