1588876270 NPI number — DR. MARTIN C DONNELLY DC,

Table of content: DR. MARTIN C DONNELLY DC, (NPI 1588876270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588876270 NPI number — DR. MARTIN C DONNELLY DC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONNELLY
Provider First Name:
MARTIN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC,
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:
1588876270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 N ADAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22201-3337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-465-1213
Provider Business Mailing Address Fax Number:
703-465-1211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 N ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22201-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-465-1213
Provider Business Practice Location Address Fax Number:
703-465-1211
Provider Enumeration Date:
05/04/2007

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: 111N00000X , with the licence number:  0104556372 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 7.002086 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 602196300 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07950876 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 698870 . This is a "CIGNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200994125 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2159023 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2159023 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200994125 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2159023 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1066011 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200994125 . This is a "GOLDEN RULE" identifier . This identifiers is of the category "OTHER".
  • Identifier: K218 . This is a "200994125" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1066011 . This is a "ASHN CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 196849 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20994125 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2159023 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".




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