1912080334 NPI number — RAMIN IPAKCHI MD

Table of content: RAMIN IPAKCHI MD (NPI 1912080334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912080334 NPI number — RAMIN IPAKCHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IPAKCHI
Provider First Name:
RAMIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1912080334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7657
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22195-7657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-499-8787
Provider Business Mailing Address Fax Number:
703-499-8222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2070 OLD BRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LAKE RIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-2495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-499-8787
Provider Business Practice Location Address Fax Number:
703-499-8222
Provider Enumeration Date:
10/21/2006

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: 207Y00000X , with the licence number:  0101236020 , 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: 13805 . This is a "GROUP ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 297595 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002468176 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061724796 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061724796 . This is a "TRICARE STANDARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 147462 . This is a "ANTHEM HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2132794 . This is a "MAMSI ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 699691 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 355366 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: J9630002 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7308573 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061724796 . This is a "GREAT WEST HC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 147462 . This is a "ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00W081P02 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213794 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061724796 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010095751 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5672456 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".