Individual
MR. TIMOTHY J RATHBUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1709
(703) 295-9360
(703) 295-9369
Mailing address
3998 FAIR RIDGE DR, SUITE 300, FAIRFAX, VA 22033-2907
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024071653
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083624548
—
VA
01
—
139180
ANTHEM
VA
01
—
300654
AMERIGROUP
VA
01
—
430039669
RAILROAD MEDICARE
VA
01
—
484645
NCPPO
VA
01
—
K142-0002
CAREFIRST
DC
Enumeration date
08/08/2006
Last updated
03/30/2015
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