Healthcare Provider Details

I. General information

NPI: 1205055621
Provider Name (Legal Business Name): MYRIAM URRUTIA-EDER, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 SHERWOOD HALL LN SUITE 203
ALEXANDRIA VA
22306-3100
US

IV. Provider business mailing address

2616 SHERWOOD HALL LN SUITE 203
ALEXANDRIA VA
22306-3154
US

V. Phone/Fax

Practice location:
  • Phone: 703-360-0594
  • Fax: 703-780-9518
Mailing address:
  • Phone: 703-360-0594
  • Fax: 703-780-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101035616
License Number StateVA

VIII. Authorized Official

Name: DR. MYRIAM URRUTIA-EDER
Title or Position: OWNER
Credential: M.D.
Phone: 703-360-0594