1417994872 NPI number — AMERICAN ANESTHESIOLOGY OF VIRGINIA PC

Table of content: (NPI 1417994872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417994872 NPI number — AMERICAN ANESTHESIOLOGY OF VIRGINIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN ANESTHESIOLOGY OF VIRGINIA 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:
FAIRFAX ANESTHESIOLOGY ASSOCIATES INC
Provider Other Organization Name Type Code:
4
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:
1417994872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 WALT WHITMAN RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-945-3000
Provider Business Mailing Address Fax Number:
844-686-2961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 GALLOWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
37-764-0017
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASCARI
Authorized Official First Name:
CLAVIO
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-243-3839

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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