1790810547 NPI number — IGNAZ P JARBADAN MD PC

Table of content: (NPI 1790810547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790810547 NPI number — IGNAZ P JARBADAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IGNAZ P JARBADAN MD 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:
6
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:
1790810547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8701 CATHEDRAL FOREST DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX STATION
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-690-2485
Provider Business Mailing Address Fax Number:
703-690-2485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9015 SILVERBROOK ROAD
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
FAIRFAX STATION
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-495-9148
Provider Business Practice Location Address Fax Number:
703-495-8447
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JARBADAN
Authorized Official First Name:
IGNAZ
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
703-495-9148

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101021817 , 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: 0001S440 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001S440 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0001S440 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 244968 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com