1942256672 NPI number — DR. RICHARD KENNETH SALL MD

Table of content: MR. REED A PRYOR DC (NPI 1841362407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942256672 NPI number — DR. RICHARD KENNETH SALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALL
Provider First Name:
RICHARD
Provider Middle Name:
KENNETH
Provider Name Prefix Text:
DR.
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:
1942256672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 JOSEPH SIEWICK DRIVE
Provider Second Line Business Mailing Address:
STE 209
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-758-2664
Provider Business Mailing Address Fax Number:
703-758-2668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 JOSEPH SIEWICK DRIVE
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-758-2664
Provider Business Practice Location Address Fax Number:
703-758-2668
Provider Enumeration Date:
05/25/2006

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: 207RI0200X , with the licence number:  0101039446 , 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: 2579781 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 318574 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4304915 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9200044 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A549I59 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 440003391 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0045913001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258946 . This is a "TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005806194 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com