Healthcare Provider Details

I. General information

NPI: 1114901477
Provider Name (Legal Business Name): WEIJIA XIA YAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MERCANTILE LN
UPPER MARLBORO MD
20774-5374
US

IV. Provider business mailing address

2101 E JEFFERSON ST
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 361-855-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101230449
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0057759
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: