Provider Demographics
NPI:1912091463
Name:RAKOWSKI, THOMAS ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:RAKOWSKI
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 1:3930 WALNUT STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4738
Mailing Address - Country:US
Mailing Address - Phone:703-246-9246
Mailing Address - Fax:703-246-9257
Practice Address - Street 1:1635 NORTH GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 215
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3606
Practice Address - Country:US
Practice Address - Phone:703-841-0707
Practice Address - Fax:703-841-0718
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020916207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010079411Medicaid
VA010079802Medicaid
VA010079527Medicaid
VA010079632Medicaid
47430006OtherCAREFIRST
4186378OtherCIGNA
VA010079462Medicaid
VA010079578Medicaid
VA010079594Medicaid
VA010079781Medicaid
1243848OtherUNITED HEALTHCARE
VA010079616Medicaid
VA010079705Medicaid
VA010079764Medicaid
VA010079888Medicaid
VA010025532Medicaid
VA010079730Medicaid
VA010199832Medicaid
VA010079781Medicaid
VA010079594Medicaid