1770976078 NPI number — DR. JOHN EDWARD NIEDERHUBER M.D.

Table of content: DR. JOHN EDWARD NIEDERHUBER M.D. (NPI 1770976078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770976078 NPI number — DR. JOHN EDWARD NIEDERHUBER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEDERHUBER
Provider First Name:
JOHN
Provider Middle Name:
EDWARD
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:
1770976078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 GALLOWS ROAD FLOOR 2
Provider Second Line Business Mailing Address:
CLAUDE MOORE BLDG.; INOVA TRANSLATIONAL MEDICINE INST.
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-776-7919
Provider Business Mailing Address Fax Number:
703-776-7177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 GALLOWS ROAD; FLOOR 2, CLAUDE MOORE BLDG.
Provider Second Line Business Practice Location Address:
INOVA HEALTH CARE SERVICES; DBA INOVA FAIRFAX HOSPITAL
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-776-7919
Provider Business Practice Location Address Fax Number:
703-776-7177
Provider Enumeration Date:
03/11/2015

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: 2086X0206X , with the licence number:  0101253101 , 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)





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