Healthcare Provider Details

I. General information

NPI: 1295873321
Provider Name (Legal Business Name): DONNA HURLOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S WHITING ST SUITE 303
ALEXANDRIA VA
22304-7100
US

IV. Provider business mailing address

205 S WHITING ST SUITE 303
ALEXANDRIA VA
22304-7100
US

V. Phone/Fax

Practice location:
  • Phone: 708-823-1533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: