1841465291 NPI number — DULLES FOOT ANKLE INSTITUTE, PLC

Table of content: (NPI 1841465291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841465291 NPI number — DULLES FOOT ANKLE INSTITUTE, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DULLES FOOT ANKLE INSTITUTE, PLC
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:
1841465291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 616
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20146-0616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-443-2000
Provider Business Mailing Address Fax Number:
703-443-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224A CORNWALL ST NW
Provider Second Line Business Practice Location Address:
LOUDOUN COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-443-2120
Provider Business Practice Location Address Fax Number:
703-443-2033
Provider Enumeration Date:
04/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
MEHUL
Authorized Official Middle Name:
JITENDRA
Authorized Official Title or Position:
SOLE PROPIERTOR
Authorized Official Telephone Number:
703-443-2000

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  0103300893 , 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: 350392 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3854800 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7980784 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2907018 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: J4630001 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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