Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 0101254202 | VA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 0101254202 | VA |
NPI | 1104988682 |
---|---|
Provider Name | Leonard Ilkhanoff |
First Address | Falls Church, VA 22042-3300 |
Second Address | Falls Church, VA 22042-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06380 | MEDICARE VIRGINIA PTAN (01) | VA |
G00773 | MEDICARE DC PTAN (01) | DC |