1013154665 NPI number — DR RHEA N.MEHRA,M.D.INC

Table of content: (NPI 1013154665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013154665 NPI number — DR RHEA N.MEHRA,M.D.INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR RHEA N.MEHRA,M.D.INC
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:
1013154665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
489 CARLISLE DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20170-4897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-953-1557
Provider Business Mailing Address Fax Number:
703-880-8414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 EISENHOWER AVE
Provider Second Line Business Practice Location Address:
SUITE # 200 ( 2ND FLOOR )
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22314-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-953-1557
Provider Business Practice Location Address Fax Number:
703-880-8414
Provider Enumeration Date:
01/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEHRA
Authorized Official First Name:
RHEA
Authorized Official Middle Name:
NISHITA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-953-1557

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 0101240596 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 0101240596 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 0101240596 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: 0101240596 , 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)