1326064163 NPI number — JOHN R WARKENTIN M.D.

Table of content: JOHN R WARKENTIN M.D. (NPI 1326064163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326064163 NPI number — JOHN R WARKENTIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARKENTIN
Provider First Name:
JOHN
Provider Middle Name:
R
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:
1326064163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 BOULDERS PKWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23225-5545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-320-4243
Provider Business Mailing Address Fax Number:
804-282-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1603 SANTA ROSA RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-320-4243
Provider Business Practice Location Address Fax Number:
804-622-0552
Provider Enumeration Date:
07/14/2006

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: 207RP1001X , with the licence number:  0101026633 , 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: 4800049 . This is a "UNITED HEALTHCARE PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 00689540 . This is a "BLACK LUNG PROVIDER NUMBE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 290003786 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006051847 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32078 . This is a "CARENET PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7101413 . This is a "MAMSI PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 021804 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 557515 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 59216 . This is a "SOUTHERN HEALTH PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 083626 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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