1962749374 NPI number — ANDREW DAVID ELKINS PA-C

Table of content: ANDREW DAVID ELKINS PA-C (NPI 1962749374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962749374 NPI number — ANDREW DAVID ELKINS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELKINS
Provider First Name:
ANDREW
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1962749374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 75420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275-5420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-383-6469
Provider Business Mailing Address Fax Number:
703-385-1062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3620 JOSEPH SIEWICK DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-1757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-810-5223
Provider Business Practice Location Address Fax Number:
703-810-5403
Provider Enumeration Date:
01/07/2013

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: 363A00000X , with the licence number:  0110004105 , 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)





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