Provider Demographics
NPI:1578682894
Name:TALANIN, NICKOLAI (MD)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAI
Middle Name:
Last Name:TALANIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 AVION PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1108
Mailing Address - Country:US
Mailing Address - Phone:703-705-7000
Mailing Address - Fax:703-763-7255
Practice Address - Street 1:14500 AVION PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1108
Practice Address - Country:US
Practice Address - Phone:703-705-7000
Practice Address - Fax:703-763-7255
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH46807Medicare UPIN
VA009715D05Medicare ID - Type Unspecified