Healthcare Provider Details

I. General information

NPI: 1356974570
Provider Name (Legal Business Name): CHAD TOUGHILL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

1433 T ST NW APT 5T
WASHINGTON DC
20009-3958
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3000
  • Fax:
Mailing address:
  • Phone: 732-674-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1291763
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: