1245208495 NPI number — JOAN S NAIDORF DO

Table of content: JOAN S NAIDORF DO (NPI 1245208495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245208495 NPI number — JOAN S NAIDORF DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAIDORF
Provider First Name:
JOAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1245208495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 PICCARD DRIVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-921-7900
Provider Business Mailing Address Fax Number:
301-921-7915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 SEMINARY ROAD
Provider Second Line Business Practice Location Address:
ALEXANDRIA HOSPITAL
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-504-3066
Provider Business Practice Location Address Fax Number:
703-504-3866
Provider Enumeration Date:
03/14/2006

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: 207P00000X , with the licence number:  0102036978 , 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: 005846111 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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