1265547947 NPI number — ANH H PHAM DDS & BARRY R MAHARAJ DDS PC

Table of content: (NPI 1265547947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265547947 NPI number — ANH H PHAM DDS & BARRY R MAHARAJ DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANH H PHAM DDS & BARRY R MAHARAJ DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHANTILLY ORAL SURGERY
Provider Other Organization Name Type Code:
3
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:
1265547947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3910 CENTERVILLE RD
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
CHANTILLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20151-3280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-668-9494
Provider Business Mailing Address Fax Number:
703-668-9495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3910 CENTERVILLE RD
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
CHANTILLY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20151-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-668-9494
Provider Business Practice Location Address Fax Number:
703-668-9495
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRIM
Authorized Official First Name:
KAITI
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
703-668-9494

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  0401006304 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X , with the licence number: 0401410305 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 105289 . This is a "TRIGON BCBS ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 555676 . This is a "MAMSI OPT CHOICE ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1696192 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1006881 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 105288 . This is a "TRIGON BCBS ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1667155 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 392375 . This is a "MAMSI OPT CHOICE ALLIANCE" identifier . This identifiers is of the category "OTHER".




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