Provider Demographics
NPI:1942423082
Name:F J PEPPER MD PC
Entity type:Organization
Organization Name:F J PEPPER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:F
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-823-2311
Mailing Address - Street 1:4600 DUKE ST
Mailing Address - Street 2:SUITE 424
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2578
Mailing Address - Country:US
Mailing Address - Phone:703-823-2311
Mailing Address - Fax:703-823-2429
Practice Address - Street 1:4600 DUKE ST
Practice Address - Street 2:SUITE 424
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2578
Practice Address - Country:US
Practice Address - Phone:703-823-2311
Practice Address - Fax:703-823-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010197472084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7133201Medicaid
B94544Medicare UPIN
408759Medicare ID - Type Unspecified