MEDICARE: DR. MARY ELIZABETH RADLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101249739	VA
2	208000000X	Pediatrics Physician	0101249739	VA

General Provider Information

NPI Number	:	1215196274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELIZABETH RADLEY MD

Provider Business Mailing Address
First Line	:	20238 BIRDSNEST PL
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-3318
Country	:	US
Telephone Number	:	914-374-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 E ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20815-6901
Country	:	US
Telephone Number	:	202-876-1663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	01/08/2026

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