NPI Code Detail JSON Logo

1659666139 NPI number — CHERYL-LYNNE DEIDRE MCCALLA D.O.

NPI Number: 1659666139
Health Care Provider/Practitioner: CHERYL-LYNNE DEIDRE MCCALLA D.O.

Information about “1659666139” NPI (CHERYL-LYNNE DEIDRE MCCALLA D.O.) exists in 1659666139 in HTML format HTML  |  1659666139 in plain Text format TXT  |  1659666139 in PDF (Portable Document Format) PDF  |  1659666139 in an XML format XML  formats.

NPI Number : 1659666139 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659666139",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCALLA",
    "FirstName": "CHERYL-LYNNE",
    "MiddleName": "DEIDRE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ARCHIBALD",
    "OtherFirstName": "CHERYL-LYNNE",
    "OtherMiddleName": "DEIDRE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.O.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2700 PROSPERITY AVE STE 270",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIRFAX",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22031-4321",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-698-2431",
    "MailingAddressFaxNumber": "571-665-6878",
    "FirstLinePracticeLocationAddress": "2700 PROSPERITY AVE STE 270",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRFAX",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22031-4321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-698-2431",
    "PracticeLocationAddressFaxNumber": "571-665-6878",
    "EnumerationDate": "06/13/2011",
    "LastUpdateDate": "05/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208D00000X",
          "TaxonomyName": "General Practice Physician",
          "LicenseNumber": "0102203396",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "0102203396",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2083A0100X",
          "TaxonomyName": "Aerospace Medicine Physician",
          "LicenseNumber": "0102203396",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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