MEDICARE: DAWN CHERI WYCKOFF 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	207Q00000X	Family Medicine Physician	0101259076	VA

General Provider Information

NPI Number	:	1356328413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN CHERI WYCKOFF MD

Provider Business Mailing Address
First Line	:	12255 FAIR LAKES PKWY
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3952
Country	:	US
Telephone Number	:	808-321-1056
Fax Number	:

Provider Business Practice Location Address
First Line	:	8008 WESTPARK DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3109
Country	:	US
Telephone Number	:	703-287-6400
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/09/2026

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