Healthcare Provider Details

I. General information

NPI: 1912091463
Provider Name (Legal Business Name): THOMAS ANTHONY RAKOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 NORTH GEORGE MASON DRIVE SUITE 215
ARLINGTON VA
22205-3606
US

IV. Provider business mailing address

3930 WALNUT STREET SUITE 101
FAIRFAX VA
22030-4738
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0707
  • Fax: 703-841-0718
Mailing address:
  • Phone: 703-246-9246
  • Fax: 703-246-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101020916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: