Healthcare Provider Details

I. General information

NPI: 1821319682
Provider Name (Legal Business Name): AVERY L BUCHHOLZ M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6244 LITTLE RIVER TPKE STE 101
ALEXANDRIA VA
22312-1714
US

IV. Provider business mailing address

6244 LITTLE RIVER TPKE STE 101
ALEXANDRIA VA
22312-1714
US

V. Phone/Fax

Practice location:
  • Phone: 843-817-5524
  • Fax: 571-248-9435
Mailing address:
  • Phone: 843-817-5524
  • Fax: 571-248-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME137026
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101263406
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: