Healthcare Provider Details

I. General information

NPI: 1912080334
Provider Name (Legal Business Name): RAMIN IPAKCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 OLD BRIDGE RD SUITE 103
LAKE RIDGE VA
22192-2495
US

IV. Provider business mailing address

PO BOX 7657
WOODBRIDGE VA
22195-7657
US

V. Phone/Fax

Practice location:
  • Phone: 703-499-8787
  • Fax: 703-499-8222
Mailing address:
  • Phone: 703-499-8787
  • Fax: 703-499-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101236020
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: