1871537365 NPI number — KEITH H CHU MD

Table of content: KEITH H CHU MD (NPI 1871537365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871537365 NPI number — KEITH H CHU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHU
Provider First Name:
KEITH
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1871537365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 ASHTON AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20109-5688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-335-8750
Provider Business Mailing Address Fax Number:
703-331-0254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 ASHTON AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109-5688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-335-8750
Provider Business Practice Location Address Fax Number:
703-331-0254
Provider Enumeration Date:
06/15/2006

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: 207RC0000X , with the licence number:  101057299 , 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: C06380 . This is a "VA PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C09878 . This is a "WHC PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 461210 . This is a "ANTHEM MANASSAS HEART" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C08583 . This is a "MHC PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2551729 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10029376 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2500646 . This is a "UNITEDHEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 505403 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 656999 . This is a "OPT/MDIPA/MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10382079 . This is a "CAQH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 147648 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5417633 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5859531 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6846536004 . This is a "CIGNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: J0600004 . This is a "CAREFIRST MANASSAS HEART" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 244654 . This is a "ANTHEM VIRGINIA CARDIO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 70670003 . This is a "CAREFIRST VCA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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