1770632630 NPI number — NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC

Table of content: (NPI 1770632630)

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".




Copyright © 2007-2025 www.npivalidator.com