1770632630 NPI number — NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC

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 1770632630 NPI number — NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES 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:
1770632630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10882 MIMOSA PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-204-1614
Provider Business Mailing Address Fax Number:
703-204-1826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 JOSEPH SIEWICK DR STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-758-8800
Provider Business Practice Location Address Fax Number:
703-758-9500
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IKHINMWIN
Authorized Official First Name:
MAGNUS
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
703-204-1614

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  0101057344 , 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: 1102268673 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2614802 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41838 . This is a "GWU HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: F078 0001 . This is a "BC CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08492993A . This is a "GEORGIA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 289502 . This is a "ALLIANCE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 319481 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005856141 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XYPLA8274 . This is a "CALIFORNIA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00B485N64 . This is a "DC MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 490807 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1121069 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 279891 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5972317 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00V069N17 . This is a "VA MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 391480 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5402030870 . This is a "AARP UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8989317 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9458135 . This is a "CALIFORNIA MEDICAID" identifier . This identifiers is of the category "OTHER".




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