1710277835 NPI number — DR. JASON BENJAMIN KATZEN M.D.

Table of content: DR. JASON BENJAMIN KATZEN M.D. (NPI 1710277835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710277835 NPI number — DR. JASON BENJAMIN KATZEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATZEN
Provider First Name:
JASON
Provider Middle Name:
BENJAMIN
Provider Name Prefix Text:
DR.
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:
1710277835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3015 WILLIAMS DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-641-9133
Provider Business Mailing Address Fax Number:
703-280-5098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2141 K ST NW
Provider Second Line Business Practice Location Address:
STE 900
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-223-9722
Provider Business Practice Location Address Fax Number:
703-328-0509
Provider Enumeration Date:
04/11/2011

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: 2085R0202X , with the licence number:  MD037939 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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