1386753291 NPI number — COUNTY OF LOUDOUN, VIRGINIA

Table of content: MR. CRAIG S KALTER M.D. (NPI 1750380150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386753291 NPI number — COUNTY OF LOUDOUN, VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF LOUDOUN, VIRGINIA
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:
Provider Other Organization Name Type Code:
6
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:
1386753291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 TRAILVIEW BLVD SE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20175-4415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-737-8677
Provider Business Mailing Address Fax Number:
703-737-8676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 HERITAGE WAY NE
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-4544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-737-8677
Provider Business Practice Location Address Fax Number:
703-737-8676
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
703-771-5406

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310500000X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 143 , 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: 004945140 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187217 . This is a "ANTHEM SLP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: LCCB . This is a "AMERIGROUP - VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004980433 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187219 . This is a "ANTHEM OT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 187220 . This is a "ANTHEM PT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008743673 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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