1588687263 NPI number — DR. ANIL R HINNARIA MD

Table of content: DR. ANIL R HINNARIA MD (NPI 1588687263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588687263 NPI number — DR. ANIL R HINNARIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINNARIA
Provider First Name:
ANIL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1588687263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12486 ROSE PATH CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-6238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-594-1755
Provider Business Mailing Address Fax Number:
703-218-8417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10390 DEMOCRACY LN
Provider Second Line Business Practice Location Address:
FAIRFAX ADS OUTPATIENT
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-591-1393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006

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: 2084P0800X , with the licence number:  0101231724 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: MD31016 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 11180633 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".