1669778080 NPI number — JOHN W KLOUSIA MD PC

Table of content: (NPI 1669778080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669778080 NPI number — JOHN W KLOUSIA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN W KLOUSIA MD 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:
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:
1669778080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 WOODLAND TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22302-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-402-7073
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7910 ANDRUS RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22306-3171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-780-5474
Provider Business Practice Location Address Fax Number:
703-799-4092
Provider Enumeration Date:
02/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KLOUSIA
Authorized Official First Name:
LEE
Authorized Official Middle Name:
Authorized Official Title or Position:
WIFE
Authorized Official Telephone Number:
703-402-7073

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 127035 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010273404 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com