1558474973 NPI number — GLENNA R ANDERSEN MD DARYA B MAANAVI MD LTD

Table of content: (NPI 1558474973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558474973 NPI number — GLENNA R ANDERSEN MD DARYA B MAANAVI MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLENNA R ANDERSEN MD DARYA B MAANAVI MD 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:
1558474973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6035 BURKE CENTRE PKWY
Provider Second Line Business Mailing Address:
SUITE 390
Provider Business Mailing Address City Name:
BURKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22015-3750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-978-1196
Provider Business Mailing Address Fax Number:
703-978-7762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8501 ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-560-1611
Provider Business Practice Location Address Fax Number:
703-573-0217
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSEN
Authorized Official First Name:
GLENNA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHYSICIAN PRESIDENT
Authorized Official Telephone Number:
703-560-1611

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com