1770641987 NPI number — DR. REBECCA HILL CHARNECO PH.D.

Table of content: DR. REBECCA HILL CHARNECO PH.D. (NPI 1770641987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770641987 NPI number — DR. REBECCA HILL CHARNECO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARNECO
Provider First Name:
REBECCA
Provider Middle Name:
HILL
Provider Name Prefix Text:
DR.
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:
1770641987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11204 WAPLES MILL RD BLDG SUITE305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-6036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-218-8500
Provider Business Mailing Address Fax Number:
703-359-0463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 FAIR RIDGE DR
Provider Second Line Business Practice Location Address:
FAIR OAKS MEDICAL BUILDING, SUITE 305
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-992-4490
Provider Business Practice Location Address Fax Number:
703-830-1847
Provider Enumeration Date:
12/04/2006

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:  0810002761 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 0810002761 , 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: 31-1822490 . This is a "TAX IDENTIFICATION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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