1538340963 NPI number — VIENNA PODIATRY LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538340963 NPI number — VIENNA PODIATRY LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIENNA PODIATRY LTD
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:
1538340963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
527 MAPLE AVE E
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22180-4746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-281-4500
Provider Business Mailing Address Fax Number:
703-242-8475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 MAPLE AVE E
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22180-4746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-281-4500
Provider Business Practice Location Address Fax Number:
703-242-8475
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STERN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
703-281-4500

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0103000238 , 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: 005868 . This is a "BLUE SHIELD OF VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 312945 . This is a "MDIPA/OPTIMUM COICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2700089 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4092107 . This is a "AETNA MC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9300431 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016712 . This is a "BLUE SHIELD OF VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0587601 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7246 . This is a "BLUE SHIELD OF DC" identifier . This identifiers is of the category "OTHER".




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