1639114523 NPI number — EDWARD G ALLCOCK DO

Table of content: EDWARD G ALLCOCK DO (NPI 1639114523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639114523 NPI number — EDWARD G ALLCOCK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLCOCK
Provider First Name:
EDWARD
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1639114523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2020
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 STE 305
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:
22205-3655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-248-0006
Provider Business Mailing Address Fax Number:
703-248-0007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 N GEORGE MASON DR STE 305
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:
22205-3655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-248-0006
Provider Business Practice Location Address Fax Number:
703-248-0007
Provider Enumeration Date:
06/17/2006

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: 208100000X , with the licence number:  0102201670 , 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: 248638 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00215424 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005623500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001K171 . This is a "FEDERAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010113831 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175536 . This is a "BLUE CROSS ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2129380 . This is a "MAM SI" identifier . This identifiers is of the category "OTHER".




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