1740281849 NPI number — IRA SANDERS YOUNG MD

Table of content: ERIKSON BAUTISTA (NPI 1578085445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740281849 NPI number — IRA SANDERS YOUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
IRA
Provider Middle Name:
SANDERS
Provider Name Prefix Text:
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:
1740281849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8503 ARLINGTON BLVD
Provider Second Line Business Mailing Address:
#310
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-208-4200
Provider Business Mailing Address Fax Number:
703-876-1799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8503 ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
#310
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-208-4200
Provider Business Practice Location Address Fax Number:
703-876-1799
Provider Enumeration Date:
08/10/2005

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: 208800000X , with the licence number:  0101017574 , 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: 4495166 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 217801 . This is a "ANTHEM MAIN OFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 291701 . This is a "ANTHEM SATELLITE OFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 502652 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: B131/0007 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".




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