1649714155 NPI number — ABOUT CARE GYN ASSOCIATES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649714155 NPI number — ABOUT CARE GYN ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABOUT CARE GYN ASSOCIATES, PLLC
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:
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:
1649714155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANTILLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20153-0925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-859-5225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 JOSEPH SIEWICK DR
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-859-5225
Provider Business Practice Location Address Fax Number:
844-898-2182
Provider Enumeration Date:
12/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DECOSIMO
Authorized Official First Name:
LILLIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN , SOLE MEMBER OWNER
Authorized Official Telephone Number:
703-859-5225

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0101053044 , 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: 6201547 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com