Healthcare Provider Details

I. General information

NPI: 1457538290
Provider Name (Legal Business Name): OLDE TOWNE OBSTETRICS & GYNECOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 MOUNT VERNON AVE
ALEXANDRIA VA
22305-2640
US

IV. Provider business mailing address

3131 MT. VERNON AVE.
ALEXANDRIA VA
22305
US

V. Phone/Fax

Practice location:
  • Phone: 703-739-8888
  • Fax: 703-519-8728
Mailing address:
  • Phone: 703-739-8888
  • Fax: 703-519-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHERYL A FERRIER
Title or Position: CEO
Credential: M.D.
Phone: 703-739-8888