Provider Demographics
NPI:1073652442
Name:BARRY L KATCHINOFF & ASSOCIATES P C
Entity Type:Organization
Organization Name:BARRY L KATCHINOFF & ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KATCHINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-272-6828
Mailing Address - Street 1:7305 BOULDER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4953
Mailing Address - Country:US
Mailing Address - Phone:804-272-6828
Mailing Address - Fax:804-320-0966
Practice Address - Street 1:7305 BOULDER VIEW LN
Practice Address - Street 2:
Practice Address - City:N CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-4953
Practice Address - Country:US
Practice Address - Phone:804-272-6828
Practice Address - Fax:804-320-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035727174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006131573Medicaid
VA130008251OtherRAILROAD MEDICARE PIN
VA130008251OtherRAILROAD MEDICARE PIN
VA130000446Medicare ID - Type Unspecified