1487754990 NPI number — JOHN HALL CHILES M.D.

Table of content: JOHN HALL CHILES M.D. (NPI 1487754990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487754990 NPI number — JOHN HALL CHILES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILES
Provider First Name:
JOHN
Provider Middle Name:
HALL
Provider Name Prefix Text:
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:
1487754990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 S. SERVICE RD.
Provider Second Line Business Mailing Address:
STE 350
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-945-3107
Provider Business Mailing Address Fax Number:
516-945-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 PARKERS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22306-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-664-7049
Provider Business Practice Location Address Fax Number:
703-295-9369
Provider Enumeration Date:
09/24/2006

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: 207LP2900X , with the licence number:  0101054929 , 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: 1487754990 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 484645 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 020717F89 . This is a "MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: K142-0001 . This is a "CARE FIRST 2005" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00411988 . This is a "PALMETTO RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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