NPI Code Detail JSON Logo

1932619210 NPI number — ANNANDALE GERONTOLOGY CLINIC

NPI Number: 1932619210
Health Care Provider/Practitioner: ANNANDALE GERONTOLOGY CLINIC

Information about “1932619210” NPI (ANNANDALE GERONTOLOGY CLINIC) exists in 1932619210 in HTML format HTML  |  1932619210 in plain Text format TXT  |  1932619210 in PDF (Portable Document Format) PDF  |  1932619210 in an XML format XML  formats.

NPI Number : 1932619210 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1932619210",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ANNANDALE GERONTOLOGY CLINIC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4216 EVERGREEN LN STE 121",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANNANDALE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22003-3256",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-893-4124",
    "MailingAddressFaxNumber": "703-662-6165",
    "FirstLinePracticeLocationAddress": "4216 EVERGREEN LN STE 121",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ANNANDALE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22003",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-893-4124",
    "PracticeLocationAddressFaxNumber": "703-662-6165",
    "EnumerationDate": "10/02/2017",
    "LastUpdateDate": "07/01/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CHOI",
    "AuthorizedOfficialFirstName": "JIHO",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/STAFF PHYSICIAN",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "301-893-4124",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207QG0300X",
        "TaxonomyName": "Geriatric Medicine (Family Medicine) Physician",
        "LicenseNumber": "0101252858",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.