Provider Demographics
NPI:1558466466
Name:VIKE, JEAN (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:VIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IPHIGENIA
Other - Middle Name:
Other - Last Name:VIKELIDOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 N OAK ST APT 817
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2764
Mailing Address - Country:US
Mailing Address - Phone:703-875-3903
Mailing Address - Fax:703-875-3903
Practice Address - Street 1:1600 N OAK ST APT 817
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2764
Practice Address - Country:US
Practice Address - Phone:703-875-3903
Practice Address - Fax:703-875-3903
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000445112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D05702Medicare UPIN