Provider Demographics
NPI:1386641959
Name:OLKIN, RAYMOND JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JAMES
Last Name:OLKIN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:STE 103, FAIRFAX MEDICAL CENTER
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6914
Mailing Address - Country:US
Mailing Address - Phone:703-273-3622
Mailing Address - Fax:703-273-0313
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:STE 103, FAIRFAX MEDICAL CENTER
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6914
Practice Address - Country:US
Practice Address - Phone:703-273-3622
Practice Address - Fax:703-273-0313
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103000250213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009303791Medicaid
VA009303791Medicaid
T30913Medicare UPIN