1912091463 NPI number — MR. THOMAS ANTHONY RAKOWSKI M.D.

Table of content: MS. MICHELE L ITO PHARM. D. (NPI 1578848933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912091463 NPI number — MR. THOMAS ANTHONY RAKOWSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAKOWSKI
Provider First Name:
THOMAS
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
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:
1912091463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3930 WALNUT STREET
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-4738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-246-9246
Provider Business Mailing Address Fax Number:
703-246-9257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 NORTH GEORGE MASON DRIVE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22205-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-841-0707
Provider Business Practice Location Address Fax Number:
703-841-0718
Provider Enumeration Date:
10/02/2006

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: 207RN0300X , with the licence number:  0101020916 , 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: 010079411 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079802 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079527 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079632 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47430006 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4186378 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010079462 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079578 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079594 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079781 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1243848 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010079616 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079705 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079764 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079888 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010025532 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010079730 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010199832 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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