1417326703 NPI number — MISS EMILY RENEE CHENARI

Table of content: MISS EMILY RENEE CHENARI (NPI 1417326703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417326703 NPI number — MISS EMILY RENEE CHENARI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENARI
Provider First Name:
EMILY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHENARI
Provider Other First Name:
EMILY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
AGACNPBC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1417326703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 IRVING ST POB NORTH
Provider Second Line Business Mailing Address:
SUITE 5000
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-877-6000
Provider Business Mailing Address Fax Number:
202-877-6618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 IRVING ST
Provider Second Line Business Practice Location Address:
PHYSICIAN'S OFFICE BUILDING NORTH SUITE 5000
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-877-6000
Provider Business Practice Location Address Fax Number:
202-877-6618
Provider Enumeration Date:
09/17/2015

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: 390200000X , with the licence number:  RN0000203094 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 0024172940 , 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: 001628748 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "UMWA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "ANTHEM MEDIGAP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "GATEWAY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "INTOTAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "OPTIMA HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 . This is a "HUMANA MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417326703 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540506332199 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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