1457305633 NPI number — DR. C ANDERSON ENGH JR. M.D.

Table of content: DR. C ANDERSON ENGH JR. M.D. (NPI 1457305633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457305633 NPI number — DR. C ANDERSON ENGH JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGH
Provider First Name:
C
Provider Middle Name:
ANDERSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENGH
Provider Other First Name:
CHARLES
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457305633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 S SHIRLINGTON RD STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22206-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-769-8423
Provider Business Mailing Address Fax Number:
703-799-5989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 S SHIRLINGTON RD STE 1100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22206-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-892-6500
Provider Business Practice Location Address Fax Number:
703-521-3415
Provider Enumeration Date:
05/20/2006

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: 207XS0114X , with the licence number:  0101041575 , 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: 1475047 . This is a "CIGNA ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5016308 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00098 . This is a "UNITED ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 502344 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4304586 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212639 . This is a "MAMSI ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0499710 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 148820100 . This is a "DEPT OF LABOR ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25090029 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 099069 . This is a "ANTHEM ID" identifier . This identifiers is of the category "OTHER".




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