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General NPI Number Information
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NPI Number | 1861533366
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Entity Type | Individual
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Provider Name | IGOR EDWARD JANKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 11/20/2022
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Provider Practice Location Address
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Address Line | 21001 SYCOLIN RD STE 360
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City | ASHBURN
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State | VA
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Zip | 20147-4331
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Country | US
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Telephone | 38-587-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 17230 TWIN MAPLE LN
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City | LEESBURG
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State | VA
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Zip | 20176-7813
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Country | US
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Telephone | 330-703-4955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101273995
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License Number State | VA
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