1215936067 NPI number — DR. DEAN G. GIANAKOS M.D.

Table of content: DR. DEAN G. GIANAKOS M.D. (NPI 1215936067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215936067 NPI number — DR. DEAN G. GIANAKOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIANAKOS
Provider First Name:
DEAN
Provider Middle Name:
G.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1215936067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 FENWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2323 MEMORIAL AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24501-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-200-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2005

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: 207R00000X , with the licence number:  0101039392 , 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: 010141826 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541457983 . This is a "TRICARE PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541457983 . This is a "PCHP PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006009832 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180728 . This is a "SOUTHERN HEALTH PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40870 . This is a "MEDCOST PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700010617 . This is a "CIGNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45436 . This is a "SENTARA/OPTIMA PROVIDER N" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60-0983-2 . This is a "VA PREMIER PROVIDER NUMBE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04-03151 . This is a "UNITED HEALTHCARE PROVIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 086705 . This is a "ANTHEM PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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