1922105477 NPI number — GERIATRICS GROUP OF NORTHERN VIRGINIA,INC.

Table of content: (NPI 1922105477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922105477 NPI number — GERIATRICS GROUP OF NORTHERN VIRGINIA,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRICS GROUP OF NORTHERN VIRGINIA,INC.
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:
1922105477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5720 MERTON COURT
Provider Second Line Business Mailing Address:
# 371
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22311-5956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-527-0932
Provider Business Mailing Address Fax Number:
571-527-0824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 S. CARLIN SPRINGS ROAD
Provider Second Line Business Practice Location Address:
SUIT # 514
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22204-1064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-527-0932
Provider Business Practice Location Address Fax Number:
571-527-0824
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALI
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-338-9526

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  010234864 , 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: 11448304 . This is a "CAQH #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9127105 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010205875 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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