1154401834 NPI number — DR. JOAN ANNETTE BOES PHD

Table of content: MR. JOSE PASTRANA (NPI 1881831246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154401834 NPI number — DR. JOAN ANNETTE BOES PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOES
Provider First Name:
JOAN
Provider Middle Name:
ANNETTE
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:
1154401834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 S WASHINGTON # 509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22314-4455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-519-7021
Provider Business Mailing Address Fax Number:
703-299-0716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
UNIT 509
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22314-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-519-7021
Provider Business Practice Location Address Fax Number:
703-299-0716
Provider Enumeration Date:
10/16/2006

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: 103TC0700X , with the licence number:  0810002462 , 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: 229329000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 103437 . This is a "ANTHUM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: J5100001 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 127238 . This is a "VALVE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3399339 . This is a "AETNA BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 463586 . This is a "MAMSI MDIPA OPTIMUM CHOIC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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