Healthcare Provider Details

I. General information

NPI: 1376117945
Provider Name (Legal Business Name): TAHITIA HOWARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5971 KINGSTOWNE VILLAGE PKWY STE 300
ALEXANDRIA VA
22315-5894
US

IV. Provider business mailing address

1104 CARLISLE PL
MT JULIET TN
37122-1025
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-7378
  • Fax: 703-717-7379
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12345
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: