1457309023 NPI number — LOUIS DUCHIN M.D.

Table of content: LOUIS DUCHIN M.D. (NPI 1457309023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457309023 NPI number — LOUIS DUCHIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUCHIN
Provider First Name:
LOUIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
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:
1457309023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23146-0366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-716-6267
Provider Business Mailing Address Fax Number:
804-477-7497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 W ELM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-632-4900
Provider Business Practice Location Address Fax Number:
717-632-3657
Provider Enumeration Date:
05/05/2006

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: 2084P0800X , with the licence number:  MD041056E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 01010155519 , 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: 176523000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2122621 . This is a "MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 088158M . This is a "SENTARA" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 10059321 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137790 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541183037 . This is a "TRICARE" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




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