Healthcare Provider Details

I. General information

NPI: 1134288137
Provider Name (Legal Business Name): SYLVIA AMANDA LARKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 BELLE HAVEN RD
ALEXANDRIA VA
22307-1201
US

IV. Provider business mailing address

2118 RAMPART DR
ALEXANDRIA VA
22308-1536
US

V. Phone/Fax

Practice location:
  • Phone: 703-765-6093
  • Fax: 703-765-7761
Mailing address:
  • Phone: 703-780-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101041481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: