Healthcare Provider Details

I. General information

NPI: 1609189414
Provider Name (Legal Business Name): PHYSICIANS OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6641 WAKEFIELD DR STE 108
ALEXANDRIA VA
22307-6859
US

IV. Provider business mailing address

6641 WAKEFIELD DR STE 108
ALEXANDRIA VA
22307-6859
US

V. Phone/Fax

Practice location:
  • Phone: 703-765-6222
  • Fax: 703-765-4554
Mailing address:
  • Phone: 703-765-6222
  • Fax: 703-765-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0101023815
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0101023815
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID K. CHOI
Title or Position: M.D.
Credential: M.D.
Phone: 703-765-6222