1922026194 NPI number — KATHLEEN SKILTON PH.D.

Table of content: KATHLEEN SKILTON PH.D. (NPI 1922026194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922026194 NPI number — KATHLEEN SKILTON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKILTON
Provider First Name:
KATHLEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1922026194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3921 OLD LEE HWY
Provider Second Line Business Mailing Address:
73-A
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-2429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-591-8668
Provider Business Mailing Address Fax Number:
703-691-8496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3921 OLD LEE HWY
Provider Second Line Business Practice Location Address:
73-A
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-591-8668
Provider Business Practice Location Address Fax Number:
703-691-8496
Provider Enumeration Date:
07/17/2006

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: 103TC0700X , with the licence number:  0810001277 , 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: 000139 . This is a "VALUOPTIONS PROVIDER ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 101366 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5512003 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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