1699060293 NPI number — DR. DINCHEN ANNA JARDINE M.D.

Table of content: DR. MONA G TSOUKLERIS PHARM.D., (NPI 1033104922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699060293 NPI number — DR. DINCHEN ANNA JARDINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARDINE
Provider First Name:
DINCHEN
Provider Middle Name:
ANNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1699060293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 PENNSYLVANIA AVE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25302-3389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-388-2980
Provider Business Mailing Address Fax Number:
304-388-2981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 PENNSYLVANIA AVE STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25302-3389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-388-2980
Provider Business Practice Location Address Fax Number:
304-388-6445
Provider Enumeration Date:
06/13/2011

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: 207Y00000X , with the licence number:  0101252383 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 0116024205 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 33573 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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