Provider Demographics
NPI:1912080334
Name:IPAKCHI, RAMIN (MD)
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:IPAKCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7657
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22195-7657
Mailing Address - Country:US
Mailing Address - Phone:703-499-8787
Mailing Address - Fax:703-499-8222
Practice Address - Street 1:2070 OLD BRIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2495
Practice Address - Country:US
Practice Address - Phone:703-499-8787
Practice Address - Fax:703-499-8222
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
13805OtherGROUP ANTHEM PPO
297595OtherAMERIGROUP
002468176OtherUNITED HEALTH CARE
061724796OtherPHCS
061724796OtherTRICARE STANDARD
147462OtherANTHEM HMO
2132794OtherMAMSI ALLIANCE
699691OtherNCPPO
355366OtherAETNA HMO
J9630002OtherCAREFIRST
7308573OtherAETNA PPO
061724796OtherGREAT WEST HC
147462OtherANTHEM PPO
00W081P02OtherMEDICARE
213794OtherOPTIMUM CHOICE
061724796OtherFIRST HEALTH
VA010095751Medicaid
5672456OtherCIGNA
I18319Medicare UPIN
VA010095751Medicaid