1275749277 NPI number — ALLERGY ASSOCIATES OF N. VIRGINIA, PLLC

Table of content: (NPI 1275749277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275749277 NPI number — ALLERGY ASSOCIATES OF N. VIRGINIA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY ASSOCIATES OF N. VIRGINIA, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275749277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 N GEORGE MASON DR
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22205-3609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-558-6040
Provider Business Mailing Address Fax Number:
703-558-6042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 N GEORGE MASON DR
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22205-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-558-6040
Provider Business Practice Location Address Fax Number:
703-558-6042
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
JOO
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
703-558-6040

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  0101239697 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7993496 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 297010 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5147476ML2 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9301453 . This is a "PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1613994 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2547291 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 762237 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0210 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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