Provider Demographics
NPI:1942256672
Name:SALL, RICHARD KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENNETH
Last Name:SALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3700 JOSEPH SIEWICK DRIVE
Mailing Address - Street 2:STE 209
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-758-2664
Mailing Address - Fax:703-758-2668
Practice Address - Street 1:3700 JOSEPH SIEWICK DRIVE
Practice Address - Street 2:STE 209
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-758-2664
Practice Address - Fax:703-758-2668
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039446207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2579781OtherAETNA HMO
318574OtherMAMSI
4304915OtherAETNA
9200044OtherUNITED HEALTHCARE
VA00A549I59Medicaid
440003391OtherRAILROAD MEDICARE
0045913001OtherCIGNA
258946OtherTRIGON
VA005806194Medicaid
VA00A549I59Medicaid
440003391OtherRAILROAD MEDICARE