Healthcare Provider Details

I. General information

NPI: 1144970682
Provider Name (Legal Business Name): PRASHANT YADAV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24430 MILLSTREAM DR
ALDIE VA
20105-3098
US

IV. Provider business mailing address

24430 MILLSTREAM DR
ALDIE VA
20105-3098
US

V. Phone/Fax

Practice location:
  • Phone: 703-957-2000
  • Fax: 800-227-1925
Mailing address:
  • Phone: 703-957-2000
  • Fax: 800-227-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0102209907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: