Provider Demographics
NPI:1245421999
Name:JOHN R. KARICKHOFF, M,D, P.C.
Entity Type:Organization
Organization Name:JOHN R. KARICKHOFF, M,D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KARICKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-536-2400
Mailing Address - Street 1:313 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3327
Mailing Address - Country:US
Mailing Address - Phone:703-536-2400
Mailing Address - Fax:
Practice Address - Street 1:313 PARK AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3327
Practice Address - Country:US
Practice Address - Phone:703-536-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20384207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAUPIN B94517Medicare UPIN
000K92J53Medicare PIN