1033103650 NPI number — DR. HENDRIKA VANDE KEMP PHD

Table of content: DR. HENDRIKA VANDE KEMP PHD (NPI 1033103650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033103650 NPI number — DR. HENDRIKA VANDE KEMP PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDE KEMP
Provider First Name:
HENDRIKA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1033103650
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:
7815 REBEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNANDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22003-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-698-8881
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7815 REBEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-698-8881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2005

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: 103TC0700X , with the licence number:  0810003170 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 6311 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 709267 . This is a "NATIONAL CAPITAL PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 700715 . This is a "AETNA/MAGELLAN PIN NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 515346 . This is a "VALUE OPTIONS/ELC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 516840 . This is a "VALUEOPTIONS/PCUSA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: G615 0001 . This is a "CAREFIRST BCBS #" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 278370 . This is a "ANTHEM BCBS IDENTIFICATIO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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