1316283914 NPI number — MS. CHRISTIANE GALLEN DAVENPORT N.P.

Table of content: MS. CHRISTIANE GALLEN DAVENPORT N.P. (NPI 1316283914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316283914 NPI number — MS. CHRISTIANE GALLEN DAVENPORT N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVENPORT
Provider First Name:
CHRISTIANE
Provider Middle Name:
GALLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

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:
1316283914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3833 FAIRFAX DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22203-1772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-525-8863
Provider Business Mailing Address Fax Number:
703-525-2387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3022 WILLIAMS DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-573-9800
Provider Business Practice Location Address Fax Number:
703-573-2959
Provider Enumeration Date:
12/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024170540 , 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)





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