1699876615 NPI number — PODIATRY CENTER-ANNANDALE PC

Table of content: (NPI 1699876615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699876615 NPI number — PODIATRY CENTER-ANNANDALE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY CENTER-ANNANDALE PC
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:
1699876615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7540 LITTLE RIVER TPKE
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
ANNANDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22003-2839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-750-1124
Provider Business Mailing Address Fax Number:
703-750-2043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7540 LITTLE RIVER TPKE
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-750-1124
Provider Business Practice Location Address Fax Number:
703-750-2043
Provider Enumeration Date:
09/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KASHANI
Authorized Official First Name:
ATOOSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
703-750-1124

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0103300978 , 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: 060211 . This is a "BLUE CROSS OF MASS." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 480019809 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212945 . This is a "MDIPA/OPT CHOICE/MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290568 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 930431 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4092107 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".