1639155369 NPI number — LORRAINE CAPPELLI PT

Table of content: LORRAINE CAPPELLI PT (NPI 1639155369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639155369 NPI number — LORRAINE CAPPELLI PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPPELLI
Provider First Name:
LORRAINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1639155369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20118-1769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-687-8181
Provider Business Mailing Address Fax Number:
540-687-8256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3031 JAVIER RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-208-1002
Provider Business Practice Location Address Fax Number:
703-208-1127
Provider Enumeration Date:
12/15/2005

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: 174400000X , with the licence number:  2305001448 , 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: K342-0012 . This is a "CAREFIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7975531 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4123410 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 175382 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3795591 . This is a "AETNA-HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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